Skip to Main Content

Epilepsy: Medical and Surgical Treatment

Epilepsy: Medical and Surgical Treatment

Dr. Tuckson speaks with Dr. Samir Karia, a pediatric neurologist, and Dr. Ian S. Mutchnick, a pediatric neurosurgeon at Norton Children's Hospital.
S14 E19 Length 27:33 Premiere: 3.31.19

Epilepsy: Medical and Surgical Treatment

Epilepsy is a neurological disorder that most often begins during childhood and can have many causes. It manifests in uncontrollable brain seizures that occur at random, with potentially life-threatening effects. Fortunately, many cases of epilepsy can be controlled through medication and even surgery.

In this episode of Kentucky Health, host Dr. Wayne Tuckson welcomes a pediatric neurologist and a pediatric neurosurgeon to discuss diagnosing epilepsy, medical treatment for the condition, and surgical options.

Dr. Samir Karia is a pediatric neurologist and Director of Epilepsy at Norton Children’s Hospital in Louisville, and Dr. Ian Mutchnick is a pediatric neurosurgeon and Surgical Director of the Pediatric Epilepsy Functional Spasticity Program at Norton’s.

“When we have a seizure, it can be because of various reasons,” Karia says. One example, he explains, would be due to low glucose (blood sugar) in the brain. “But when we have a seizure that happens repeatedly, then we consider it epilepsy.”

Diagnosing Epilepsy
As noted above, epilepsy can be caused by various underlying conditions that affect the central nervous system. These can include genetic diseases such as Dravet syndrome or Aicardi syndrome, both of which begin in infancy and are lifelong conditions. Aicardi syndrome, caused by a defect in the X chromosome, predominantly affects infant girls.

Epilepsy can also be caused by a structural abnormality in the brain or a developmental abnormality, Karia says. Brain tumors can also cause epilepsy, and so can traumatic injuries to the brain.

“I guess the way I see it is that a seizure is something you can have, and you can have it in conjunction with something else,” Mutchnick says. “It certainly represents something wrong. Sometimes we can see it – we get a scan, and it shows a tumor, and voila! Sometimes you can’t see it. But either way, it arises from some abnormality. If you have epilepsy, that means you have regular seizures, multiple times.”

Karia says that about 5 out of 100 children will have febrile seizures – seizures as a result of fever. This age group ranges from six months to five years of age. Having febrile seizures does not increase the chances of having epilepsy in the future, however.

Febrile seizures have a genetic component, and so do epileptic seizures, Karia says. “If a single patient presents with seizures, there’s a one in five likelihood that they occurred due to inherited reasons. The remaining four out of five patients do not have any positive family history. So it depends on the specific type of the gene and the specific type of the epilepsy.”

Incidence rates for epilepsy have increased in recent years, but Karia says that is due to advances in diagnosing the condition. Neurologists have more precise tools to examine brain wave activity nowadays, with the EEG (electroencephalogram) being the primary diagnostic tool.

The EEG is “a common test we do in which we put electrodes over the brain similar to when we put them over the heart to monitor heart rhythm,” Karia says. “Here, we monitor brain wave activity. If there are disturbances in the electrical charges, those can be a tell-tale sign for seizures.”

As for warning signs of epilepsy, Mutchnick says, “I would say that, if you see your kid doing something weird, bring him in for an evaluation – especially if it involves any compromise in their level of consciousness.”

A child waking up in the morning with oral bleeding, or unexplained vomiting during the night, can be evidence of seizures, Karia says. A certain type of epilepsy called photosensitive epilepsy can be triggered by blinking lights or other visual stimulation, he adds. “It’s very important that if there are unusual symptoms that happen over and over again, those may be indicative of a seizure,” he cautions, “and it needs to be evaluated right away.”

Medical Options and Surgical Procedures
There are two treatment goals for epilepsy, Karia says. The first priority is to stop a seizure if it is happening and if it won’t stop spontaneously. “That’s what we call rescue therapy,” he says. “The other part is, we try to avoid the recurrence of seizures, and we call that prophylaxis, seizure prophylactic treatment.”

Certain medications are used to treat seizures, and the criteria is determined by various factors, according to Karia: these include the patient’s age, genetic inheritance, and any abnormalities that are found through imaging tests.

Also, Karia says that it’s very important for the neurologist and his/her team to ascertain how frequent the seizures are, and how severe. Seizures that require a trip to the emergency room each time they occur will require different treatment than those that can be managed by intervention at the site.

Initial EEG tests will provide enough information for Karia and his staff to explore treatment protocols. “If we do find a structural abnormality, then we know that we may need surgical intervention and we need evaluation and admitting the patient into the hospital, what we call epilepsy monitoring units,” he says.

At this point, Mutchnick and his team collaborate with Karia in order to find a surgical procedure that can either make the seizures stop completely or become less severe. But there is more to consider.

“In parallel with trying to locate where the seizure is coming from, we’re also trying to start to understand where different functions are in this patient,” he says, “because we also want to get a sense of what the cost is of potentially taking out this epileptogenic focus in the brain.”

For example, Mutchnick says that if he finds that a right frontal lesion is causing debilitating epilepsy, and he can pinpoint the correct area on the right frontal lobe, it is possible that the lesion could be removed without any major loss of function in the patient. On the other hand, if the affected area is in the left temporal lobe and extends back several centimeters, then it may exist in the area where the patient’s primary language and memory abilities are.

“You have to go to the parents and say, ‘Well, we could take this out, but it is likely to leave the patient with a deficit,” Mutchnick says. “And in almost all cases, what emerges is not some conclusive crystal ball kind of decision, what emerges is a choice between the morbidity of having something resected or fiddled with in your brain and how likely it is that you are going to see a benefit of some defined level. And really, it’s up to us and the parents to collaborate well enough to achieve decision quality then, on what happens next.”

Mutchnick says that the imaging software he uses today allows him and his team to integrate multiple visual data streams into a composite that provides a view of the brain from multiple vantage points. He presents a series of slides showing traditional MRI, CT, and X-ray scans, each of which display different visual information, and then presents an image from the software package he currently uses that produces a more lifelike and detailed rendering.

“When we look at this picture, there’s no escaping knowledge that’s relevant to making good decisions for this patient,” he says. “That’s why I think that this kind of software is going to be increasingly a part of any epilepsy service.”

Program Details

Kentucky Health

About Kentucky Health

Learn how to improve your health through education and increased awareness. Dr. Wayne Tuckson, a colorectal surgeon in Louisville, hosts.

TV Schedules

Jump to Recent Airdates

Upcoming

GERD: A Burning in the Chest and a Whole Lot More

Gastroesophageal Reflux Disease, also known as GERD, is a painful but common condition caused by irritation in the lining of the esophagus. Dr. Tuckson talks with Jeff Allen, M.D., director of laparoscopic surgery at Norton Surgical Specialists, about surgical options for GERD.

  • Friday October 22, 2021 1:30 pm ET on KETKY
  • Friday October 22, 2021 12:30 pm CT on KETKY
  • Friday October 22, 2021 6:00 pm ET on KET
  • Friday October 22, 2021 5:00 pm CT on KET
  • Friday October 22, 2021 11:30 pm ET on KET
  • Friday October 22, 2021 10:30 pm CT on KET
  • Sunday October 24, 2021 12:30 am ET on KETKY
  • Saturday October 23, 2021 11:30 pm CT on KETKY
  • Sunday October 24, 2021 9:00 am ET on KETKY
  • Sunday October 24, 2021 8:00 am CT on KETKY
  • Sunday October 31, 2021 7:00 am ET on KET2
  • Sunday October 31, 2021 6:00 am CT on KET2

Lung Cancer: Improving Treatment and Decreasing the Mortality

Though lung cancer remains the leading cause of death from cancer in the United States, there is cause for optimism. Dr. Tuckson talks to Jason Chesney, M.D., director of the UofL Health-Brown Cancer Center in Louisville, about new developments in the treatment of lung cancer.

  • Sunday October 24, 2021 7:00 am ET on KET2
  • Sunday October 24, 2021 6:00 am CT on KET2

Carotid Artery Disease: A Precursor to a Stroke

Carotid artery disease can cut off the flow of blood to the brain, potentially causing a stroke. Dr. Tuckson discusses life-saving surgical solutions for carotid artery disease with Nick Abedi, M.D., a vascular surgeon with Fayette Surgical Associates.

  • Sunday October 24, 2021 12:30 pm ET on KET
  • Sunday October 24, 2021 11:30 am CT on KET
  • Sunday October 24, 2021 5:30 pm ET on KETKY
  • Sunday October 24, 2021 4:30 pm CT on KETKY
  • Monday October 25, 2021 2:00 pm ET on KET2
  • Monday October 25, 2021 1:00 pm CT on KET2
  • Friday October 29, 2021 1:30 pm ET on KETKY
  • Friday October 29, 2021 12:30 pm CT on KETKY
  • Friday October 29, 2021 6:00 pm ET on KET
  • Friday October 29, 2021 5:00 pm CT on KET
  • Friday October 29, 2021 11:30 pm ET on KET
  • Friday October 29, 2021 10:30 pm CT on KET
  • Sunday October 31, 2021 12:30 am ET on KETKY
  • Saturday October 30, 2021 11:30 pm CT on KETKY
  • Sunday October 31, 2021 9:00 am ET on KETKY
  • Sunday October 31, 2021 8:00 am CT on KETKY
  • Sunday November 7, 2021 7:00 am ET on KET2
  • Sunday November 7, 2021 6:00 am CT on KET2

Environmental Pollution: Trees and Bushes as the Fix

Ted Smith, Ph.D., the director of the Center for Healthy Air, Water and Soil at the UofL Christina Lee Brown Envirome Institute, talks about how planting trees can reduce air pollution, decrease certain health risks and encourage participation in outdoor activities.

  • Sunday October 31, 2021 12:30 pm ET on KET
  • Sunday October 31, 2021 11:30 am CT on KET
  • Sunday October 31, 2021 5:30 pm ET on KETKY
  • Sunday October 31, 2021 4:30 pm CT on KETKY
  • Monday November 1, 2021 2:00 pm ET on KET2
  • Monday November 1, 2021 1:00 pm CT on KET2
  • Friday November 5, 2021 1:30 pm ET on KETKY
  • Friday November 5, 2021 12:30 pm CT on KETKY
  • Friday November 5, 2021 6:00 pm ET on KET
  • Friday November 5, 2021 5:00 pm CT on KET
  • Friday November 5, 2021 11:30 pm ET on KET
  • Friday November 5, 2021 10:30 pm CT on KET
  • Sunday November 7, 2021 12:30 am ET on KETKY
  • Saturday November 6, 2021 11:30 pm CT on KETKY
  • Sunday November 7, 2021 9:00 am ET on KETKY
  • Sunday November 7, 2021 8:00 am CT on KETKY
  • Sunday November 14, 2021 7:00 am ET on KET2
  • Sunday November 14, 2021 6:00 am CT on KET2

Glaucoma and Cataracts: What's Clear and Are They Inevitable?

Dr. Tuckson talks with ophthalmologist Frank Burns, MD, of Middletown Eye Care, about glaucoma and cataracts.

  • Sunday November 7, 2021 12:30 pm ET on KET
  • Sunday November 7, 2021 11:30 am CT on KET
  • Sunday November 7, 2021 5:30 pm ET on KETKY
  • Sunday November 7, 2021 4:30 pm CT on KETKY
  • Monday November 8, 2021 2:00 pm ET on KET2
  • Monday November 8, 2021 1:00 pm CT on KET2
  • Friday November 12, 2021 1:30 pm ET on KETKY
  • Friday November 12, 2021 12:30 pm CT on KETKY
  • Friday November 12, 2021 6:00 pm ET on KET
  • Friday November 12, 2021 5:00 pm CT on KET
  • Friday November 12, 2021 11:30 pm ET on KET
  • Friday November 12, 2021 10:30 pm CT on KET
  • Sunday November 14, 2021 12:30 am ET on KETKY
  • Saturday November 13, 2021 11:30 pm CT on KETKY
  • Sunday November 14, 2021 9:00 am ET on KETKY
  • Sunday November 14, 2021 8:00 am CT on KETKY
  • Sunday November 21, 2021 7:00 am ET on KET2
  • Sunday November 21, 2021 6:00 am CT on KET2

Medical Information: Discerning the Wheat from the Chaff

  • Sunday November 14, 2021 12:30 pm ET on KET
  • Sunday November 14, 2021 11:30 am CT on KET
  • Sunday November 14, 2021 5:30 pm ET on KETKY
  • Sunday November 14, 2021 4:30 pm CT on KETKY
  • Monday November 15, 2021 2:00 pm ET on KET2
  • Monday November 15, 2021 1:00 pm CT on KET2
  • Friday November 19, 2021 1:30 pm ET on KETKY
  • Friday November 19, 2021 12:30 pm CT on KETKY
  • Friday November 19, 2021 6:00 pm ET on KET
  • Friday November 19, 2021 5:00 pm CT on KET
  • Friday November 19, 2021 11:30 pm ET on KET
  • Friday November 19, 2021 10:30 pm CT on KET
  • Sunday November 21, 2021 12:30 am ET on KETKY
  • Saturday November 20, 2021 11:30 pm CT on KETKY
  • Sunday November 21, 2021 9:00 am ET on KETKY
  • Sunday November 21, 2021 8:00 am CT on KETKY

Oral Cancer and HPV: The Surprising Connection

  • Sunday November 21, 2021 12:30 pm ET on KET
  • Sunday November 21, 2021 11:30 am CT on KET
  • Sunday November 21, 2021 5:30 pm ET on KETKY
  • Sunday November 21, 2021 4:30 pm CT on KETKY
Jump to Upcoming Airdates

Recent

GERD: A Burning in the Chest and a Whole Lot More

  • Monday October 18, 2021 2:00 pm ET on KET2
  • Monday October 18, 2021 1:00 pm CT on KET2
  • Sunday October 17, 2021 5:30 pm ET on KETKY
  • Sunday October 17, 2021 4:30 pm CT on KETKY
  • Sunday October 17, 2021 12:30 pm ET on KET
  • Sunday October 17, 2021 11:30 am CT on KET

Lung Cancer: Improving Treatment and Decreasing the Mortality

  • Sunday October 17, 2021 9:00 am ET on KETKY
  • Sunday October 17, 2021 8:00 am CT on KETKY
  • Sunday October 17, 2021 12:30 am ET on KETKY
  • Saturday October 16, 2021 11:30 pm CT on KETKY
  • Friday October 15, 2021 11:30 pm ET on KET
  • Friday October 15, 2021 10:30 pm CT on KET
  • Friday October 15, 2021 6:00 pm ET on KET
  • Friday October 15, 2021 5:00 pm CT on KET
  • Friday October 15, 2021 1:30 pm ET on KETKY
  • Friday October 15, 2021 12:30 pm CT on KETKY
  • Monday October 11, 2021 2:00 pm ET on KET2
  • Monday October 11, 2021 1:00 pm CT on KET2
  • Sunday October 10, 2021 5:30 pm ET on KETKY
  • Sunday October 10, 2021 4:30 pm CT on KETKY
  • Sunday October 10, 2021 12:30 pm ET on KET
  • Sunday October 10, 2021 11:30 am CT on KET

Nutrition and Weight Management

  • Sunday October 10, 2021 7:00 am ET on KET2
  • Sunday October 10, 2021 6:00 am CT on KET2

Medications: A Modern Miracle, But Are They Safe and Available

  • Sunday October 17, 2021 7:00 am ET on KET2
  • Sunday October 17, 2021 6:00 am CT on KET2
  • Sunday October 10, 2021 9:00 am ET on KETKY
  • Sunday October 10, 2021 8:00 am CT on KETKY
  • Sunday October 10, 2021 12:30 am ET on KETKY
  • Saturday October 9, 2021 11:30 pm CT on KETKY
  • Friday October 8, 2021 11:30 pm ET on KET
  • Friday October 8, 2021 10:30 pm CT on KET
  • Friday October 8, 2021 6:00 pm ET on KET
  • Friday October 8, 2021 5:00 pm CT on KET
  • Friday October 8, 2021 1:30 pm ET on KETKY
  • Friday October 8, 2021 12:30 pm CT on KETKY
  • Monday October 4, 2021 2:00 pm ET on KET2
  • Monday October 4, 2021 1:00 pm CT on KET2
  • Sunday October 3, 2021 5:30 pm ET on KETKY
  • Sunday October 3, 2021 4:30 pm CT on KETKY
  • Sunday October 3, 2021 12:30 pm ET on KET
  • Sunday October 3, 2021 11:30 am CT on KET

The Immune System: Not Just Fighting Infections

  • Sunday October 3, 2021 9:00 am ET on KETKY
  • Sunday October 3, 2021 8:00 am CT on KETKY
  • Sunday October 3, 2021 7:00 am ET on KET2
  • Sunday October 3, 2021 6:00 am CT on KET2
  • Sunday October 3, 2021 12:30 am ET on KETKY
  • Saturday October 2, 2021 11:30 pm CT on KETKY
  • Friday October 1, 2021 11:30 pm ET on KET
  • Friday October 1, 2021 10:30 pm CT on KET
  • Friday October 1, 2021 6:00 pm ET on KET
  • Friday October 1, 2021 5:00 pm CT on KET
  • Friday October 1, 2021 1:30 pm ET on KETKY
  • Friday October 1, 2021 12:30 pm CT on KETKY
  • Sunday September 26, 2021 5:30 pm ET on KETKY
  • Sunday September 26, 2021 4:30 pm CT on KETKY
  • Sunday September 26, 2021 12:30 pm ET on KET
  • Sunday September 26, 2021 11:30 am CT on KET

New Approaches to Shoulder Replacement

  • Monday September 27, 2021 2:00 pm ET on KET2
  • Monday September 27, 2021 1:00 pm CT on KET2
  • Sunday September 26, 2021 9:00 am ET on KETKY
  • Sunday September 26, 2021 8:00 am CT on KETKY
  • Sunday September 26, 2021 7:00 am ET on KET2
  • Sunday September 26, 2021 6:00 am CT on KET2
  • Sunday September 26, 2021 12:30 am ET on KETKY
  • Saturday September 25, 2021 11:30 pm CT on KETKY
  • Friday September 24, 2021 11:30 pm ET on KET
  • Friday September 24, 2021 10:30 pm CT on KET
  • Friday September 24, 2021 6:00 pm ET on KET
  • Friday September 24, 2021 5:00 pm CT on KET
  • Sunday September 19, 2021 5:30 pm ET on KETKY
  • Sunday September 19, 2021 4:30 pm CT on KETKY
  • Sunday September 19, 2021 12:30 pm ET on KET
  • Sunday September 19, 2021 11:30 am CT on KET

Oral Healthcare: Our Teeth Should Last a Lifetime

  • Monday September 20, 2021 2:00 pm ET on KET2
  • Monday September 20, 2021 1:00 pm CT on KET2
  • Sunday September 19, 2021 9:00 am ET on KETKY
  • Sunday September 19, 2021 8:00 am CT on KETKY
  • Sunday September 19, 2021 7:00 am ET on KET2
  • Sunday September 19, 2021 6:00 am CT on KET2
  • Sunday September 19, 2021 12:30 am ET on KETKY
  • Saturday September 18, 2021 11:30 pm CT on KETKY
Top

Season 14 Episodes

2019 Legislative Review: Bills Related to Health and Health

S14 E25 Length 26:47 Premiere Date 5.12.19

Lead and Other Everyday Environmental Dangers

S14 E24 Length 26:59 Premiere Date 5.5.19

Tobacco Cessation: The Power of Group Education and Support

S14 E23 Length 28:46 Premiere Date 4.28.19

Quality and Safety in Healthcare: What's Important

S14 E22 Length 27:07 Premiere Date 4.21.19

Vaccinations: Who, What, When, and Why?

S14 E21 Length 26:33 Premiere Date 4.14.19

The Adolescent Brain and Substance Use

S14 E20 Length 27:09 Premiere Date 4.7.19

Epilepsy: Medical and Surgical Treatment

S14 E19 Length 27:33 Premiere Date 3.31.19

Community Health Workers: Care Away from the Clinic

S14 E18 Length 27:23 Premiere Date 3.24.19

The Flu: It's Not Just a Bad Cold

S14 E17 Length 26:56 Premiere Date 2.24.19

Financial and Mechanical Ways to Protect Our Teeth

S14 E16 Length 27:07 Premiere Date 2.17.19

Aging Optimally

S14 E15 Length 27:15 Premiere Date 2.10.19

Colon Cancer: To Screen or Not to Screen Is Not a Question

S14 E14 Length 27:16 Premiere Date 2.3.19

Autism

S14 E13 Length 26:34 Premiere Date 1.27.19

Leukemia and Lymphoma

S14 E12 Length 26:59 Premiere Date 1.20.19

Hypertension: The Silent but Consequential Disease

S14 E11 Length 26:57 Premiere Date 1.13.19

Genetic Testing: Not a Parlor Game

S14 E10 Length 27:01 Premiere Date 1.6.19

Trauma and Toxic Stress

S14 E9 Length 26:57 Premiere Date 12.16.18

Cancer and Immunotherapy

S14 E8 Length 27:10 Premiere Date 12.9.18

Intestinal Biome: We're in This Gut Together

S14 E7 Length 27:47 Premiere Date 11.18.18

Community Health Centers: Taking the Clinic to the Patient

S14 E6 Length 27:20 Premiere Date 11.11.18

Arthritis

S14 E5 Length 26:58 Premiere Date 11.4.18

Thyroid Disease

S14 E4 Length 27:21 Premiere Date 10.28.18

Breast Cancer

S14 E3 Length 27:05 Premiere Date 10.21.18

Weight Loss: Reasons, Options, Benefits

S14 E2 Length 28:48 Premiere Date 10.14.18

Chiropractic: A Good Back and Neck for a Healthy Body

S14 E1 Length 25:23 Premiere Date 10.7.18

Explore KET