Q&A on Epilepsy with Professor Martin Brodie

Although epilepsy is the most common neurological condition in the UK, over a quarter of epilepsy patients say they experience stigma as a result of the condition. Experts warn that the resulting psychological impact can be just as damaging as the seizures themselves.

We are delighted to present a detailed introduction to the subject of epilepsy in the form of a Q&A session with internationally renowned epilepsy expert Professor Martin Brodie.

PATIENTTALK.ORG – What, actually, is epilepsy?

PROFESSOR MARTIN BRODIE – . It’s the most complicated question because it’s a lot of different things and the bottom line is it’s a condition where people get unprovoked seizures that is seizures with no obvious provocation that you can then prevent and therefore prevent the actual seizures and the causes are thousands and thousands, anything that can affect the brain.

In about two thirds of cases there is an anatomical cause, sometimes we can see it on the scan increasingly so, sometimes not. In a third it’s due to low seizure threshold with a genetic component that may not be familiar in some situations that is a singular genetic mutation. In others it’s polygenetic and there’s a lot of different genes involved and so you can have seizures from infancy, from when you were born until when you are in old age and the commonest time now to develop epilepsy is in later life. With over 3% of over 80’s having seizures because they will have a possibility of things like strokes, vascular disease, hypertension, diabetes, dementia and all of these can result in seizures.

The interesting thing is not everybody gets the seizures and you know if you’re looking at say people with brain tumours which is an obvious cause of seizures for me the interesting question for me is not why 10% of people get seizures but why do the other 90% not get seizures, and so what we can see we don’t know the cause of we can get some idea of the possible mechanisms but the actual specific mechanism that the actual individual has is not available to us so therefore we cannot just pick the best drug we have to try the drugs out and try different drugs.

PATIENTTALK.ORG – Are there any clear symptoms of Epilepsy?

PROFESSOR MARTIN BRODIE – Well it depends on the type of Epilepsy that you have, sometimes in children they can stare straight ahead and miss stuff at school, sometimes the hands can jerk and jump or people can fall, sometimes they can stare into space and turn their head and look away and these are focal seizures and of course the severe ones where you fall down, jerk and shake all over, bite your tongue and don’t breathe during it, these are the tonic chronic seizures so there are lots of different types.

PATIENTTALK.ORG – And what are the long term struggles with the condition?

PROFESSOR MARTIN BRODIE – About two thirds of patients we can actually prevent the seizures with reasonable doses of medication and for many of these people after 6 months or a year they can get their driving licence back, you can get employment although there is still stigma against that and you can live a pretty normal life, you know you can’t fly an aeroplane but there’s a lot of other things that you can reasonably do. Unfortunately about a third of people that we don’t fully control the seizures and there it’s really life changing and these people don’t drive, they often have difficulty getting employment and I’m sure my two colleagues can tell you better than me how it effects their lives.

PATIENTTALK.ORG – Ok and what is idiopathic generalized epilepsy?

PROFESSOR MARTIN BRODIE – There are three main causes of idiopathic generalized epilepsy are the absence seizures usually in children and teenagers where they stare straight ahead, myoclonic seizures where their body jerks and then the tonic chronic seizures. The international league against epilepsy has brought out a new classification and I was actually on the body that did that so that we can get away from these terms that no one understands and doesn’t make any sense, so we are now talking about focal epilepsy where the problem is in one part of the brain or genetic epilepsy where there is a lower seizure threshold and there’s a malfunction so the idiopathic generalized epilepsy are the genetic epilepsy.

PATIENTTALK.ORG – And are there any other different types of epilepsy other than those that you have mentioned?

PROFESSOR MARTIN BRODIE – Well there are few rarer types in kids who have these seizures often with single gene mutations affecting the function of the brain, in older people there are a group of conditions called progressive myoclonic epilepsy which again are also single genes although there may be different genes and this causes jerking and seizures and often people can’t even walk because of the severity of it so really anything that can affect the brain as well firstly produce seizures and they are often different.

PATIENTTALK.ORG – Ok and I was going to ask what the relationship between autism and epilepsy is?

PROFESSOR MARTIN BRODIE – Autistic spectrum disorder is what we now call it as we realised its most things it’s not just one problem and I’m not involved in that area although we have patients coming to my clinic who have this problem and this is sort of a malfunction in the brain where the brain doesn’t fully function but if you actually do a brain scan it looks normal it just doesn’t function and a number of patients with autism also have seizures and that’s why they come to me otherwise they get sent to a specialist who works within that area and people with autism can be very intelligent or they can be not intelligent and again that can be one of the reasons to why it’s called Autistic spectrum disorder because the term covers different disorders.

PATIENTTALK.ORG – Ok are there any other conditions where comorbidity with epilepsy is common?

PROFESSOR MARTIN BRODIE – Yes any condition that effects the brain can be associated with seizures because seizures are evidence of brain dysfunction, so is depression, so is anxiety, anything that can affect the brain and many patients who have epilepsy also have one or other of these other symptoms, about a third of patients with newly diagnosed epilepsy also have depression or anxiety to a degree, about a half of patients with difficulties to control the epilepsy have psychiatric comorbidity because if you think about it these are all symptoms of brain dysfunction so it’s not surprising if the brains not working terribly well if they have different symptoms and the more of these symptoms that you have the more difficult the seizures are to control and we do try to control the other symptoms with the other medication and some of my drugs actually work for depression, some of them make depression worst so there is a pharmacological overlap between all these conditions that are associated with brain dysfunction.