Posted: Monday, September 11, 2017

Diagnosing and Treating Epilepsy

Epilepsy is a common and disabling neurological disorder, affecting about 3 million people in the United States. While seizures (caused by bursts of electrical discharges in the brain) from epilepsy can be frightening, most can successfully be managed when diagnosed and treated by a neurologist specializing in epilepsy. Blount Memorial board-certified neurologist Dr. Faiz Rehmani, who is fellowship-trained in epilepsy, explains.

“The diagnosis of epilepsy often is made by a general neurologist based on the clinical exam and on the description of events by patient, family and friends,” says Rehmani, who sees patients at East Tennessee Medical Group – Neurology in the Blount Memorial Physician Office Building. “Subsequent testing with an EEG [electroencephalography, measuring electrical activity of the brain] helps in the diagnosis and classification of seizure type, and often guides treatment choice. The EEG also can help monitor efficacy of treatment. For new onset seizures, MRI [magnetic resonance imaging] of the brain also is performed to determine if there are any structural issues in the brain that could lead to the seizures.”

In cases where there is difficulty distinguishing between epileptic and non-epileptic spells, or when spells or seizures can’t be managed with treatment, patients typically are referred to a neurologist who specializes in epilepsy. Rehmani, who has extra training in the management of patients with complex medically refractory epilepsy, also is trained to interpret special diagnostic tests such as prolonged video-EEG monitoring, which simultaneously records and displays a patient’s brainwaves and physical actions.
Rehmani adds, “Currently, we work with third-party vendors to provide prolonged, ambulatory, in-home video EEG monitoring, and I interpret the results. We also are about to start an epilepsy monitoring unit at Blount Memorial where we can safely admit patients and discontinue/adjust medications in the hospital while monitoring for seizures/spells.”

Seizures and spells often can be managed with anti-epileptic medications, says Rehmani, adding that more than one anti-epileptic medication commonly is necessary to keep seizures under control.
He explains, “The choice of medications can be tricky, given that they have different mechanisms of action, some medications are more effective for certain types of epilepsy than others, and the medications interact with one another as well as with other medications the patient may be taking.”

Patients whose seizures cannot be controlled with multiple anti-epileptic medications may be candidates for epilepsy surgery. Rehmani emphasizes that the decision to recommend surgery is a long and meticulous process requiring further testing to identify the focus (or foci) or region of the brain from which seizures begin.

To request a referral or schedule an appointment with Dr. Rehmani,
call 865-980-5230.

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