In honor of Purple Day for Epilepsy on March 26th, we have partnered with Boston Children’s Hospital to play a part in spreading awareness and sharing knowledge for our community of clinicians. We spoke with Dr. Jeffrey Bolton to learn more about epilepsy and what PCPs can do to best help their patients with this condition.
Dr. Jeffrey Bolton is a physician in the Division of Epilepsy and Neurophysiology in the Department of Neurology at Boston Children’s Hospital specializing in epilepsy in children. In addition to his role as a physician, Dr. Bolton is an Instructor of Neurology at Harvard Medical School.
Purple Day for Epilepsy is a day that many countries participate in to raise awareness about epilepsy by wearing purple and hosting events to support this cause.
Until recently, epilepsy was defined as having two or more unprovoked seizures. The definition now includes patients who have had one unprovoked seizure and a high probability of a subsequent event; this would include having an abnormal EEG or MRI.
Epilepsy can have many causes, including genetics. Some patients do inherit epilepsy from their relatives, but others may have genetic epilepsy which occurs anew or spontaneously. Other causes include brain malformations, strokes, traumatic brain injury, and central nervous system (CNS) infections.
Anti-seizure medications are the mainstay of epilepsy treatment. Medication should be chosen based upon the patient’s epilepsy syndrome as well as taking into account the side effect profile.
It can be a bit of trial and error where patients need close follow-up with their neurologist in the early stages. Once a suitable medication is found, there should be visits a few times a year to check-in. Unfortunately, about ⅓ of patients may not have complete seizure control with medications. For this population, other treatment options should be considered, such as epilepsy surgery, ketogenic diet, or neurostimulators.
One of the most important aspects of epilepsy treatment is good medication compliance and should be reinforced at any routine encounter with their PCP. Moreover, if a patient continues to have seizures despite trying two or more medications, they should be referred to an epilepsy center.
There are many exciting developments in the treatment of epilepsy on the near horizon. Patients with genetic epilepsy syndromes may soon have more targeted treatments based upon their specific mutation. Boston Children’s has a world-renown Epilepsy Genetics Program. Another development is the advancement of more minimally invasive techniques using laser ablation for select patients. This substantially improves the post-operative recovery period.
Epilepsy can be a very unpredictable disease. Children with epilepsy often have much higher rates of anxiety and school difficulty. It is important to be on the lookout for these comorbidities and intervene early. I would encourage PCPs to try to normalize the child’s epilepsy, as people with epilepsy should be encouraged to live as normal of a life as possible.