Epilepsy Specialist

What is epilepsy?

A person is considered to have epilepsy when they experience two or more unprovoked seizures. It is a neurological condition marked by abnormal electrical discharges in the brain and manifesting as episodes of decreased responsiveness, abnormal behavior, automatic limbs movements, abnormal sensory phenomenon or at its extreme, generalized convulsions.

Epilepsy most commonly appears in childhood, adolescence or late adulthood and is the result of various causes. While it can be hereditary, some cases are the result of events such as head trauma, brain infection, brain tumor or stroke. Along with different causes, there are various forms of epilepsy. Each has its own symptoms, needs, course and potential complications. To accurately treat epilepsy, it is necessary to correctly diagnose it.

Are all seizures cases of epilepsy?

No. Paroxysmal non-epileptic seizures are seizure-like episodes that are not of seizure origin. They are the result of psychological or physiological, rather than neurological, conditions, and as such require different treatment from that of epilepsy. Dr. Lerman diagnoses paroxysmal non-epileptic seizures.

When should I visit a doctor?

Symptoms of seizure disorder can vary greatly. However, it is important to consult with a doctor in the event of:

• Seizure
• Unexplained episodes loss of consciousness
• Unexplained shaking or rigidity
• Unexplained memory loss
• Staring episodes
• Abnormal sleep behavior
• Waking up with evidence of unexplained blood
• Episodes of decreased responsiveness

Diagnosis of epilepsy

Accurately diagnosing seizures is key in treating epilepsy. Dr. Lerman provides diagnosis for both epilepsy and non-epilepsy seizures in young adults and adults in order to prescribe the optimal course of treatment. In addition to neurological examination, neuropsychological assessment and blood analysis, the practice performs in-home and in-hospital monitoring to help localize seizure onsets, hoping to optimize medication regiments and in some cases providing pre-surgical work-up or preparation in determining candidacy for surgical interventions, such as resective surgery.

• Video Electroencephalogram (EEG) - Epilepsy monitoring is offered to patients at home, at the office or in-hospital in which electrodes placed on the head are used to record brain activity and seizure events over the course of several days. Long-term monitoring is also offered.
• Intracranial electrode monitoring (iEEG or ECoG) - Pre-surgical work up for in-patient intervention in which electrodes are placed on the brain to precisely identify epileptic areas of the brain.
• Neuroimaging tests - Various imaging methods used to identify epilepsy cases caused by changes in the brain’s structure.
• Computerized tomography (CT) scan - One of the most commonly used neuroimaging tests, this series of x-rays offers a three-dimensional detailed picture of the brain to detect abnormalities.
• Magnetic resonance imaging (MRI) - Offered in-house and one of the most commonly used neuroimaging tests, the MRI provides a precise image of the brain’s structure, allowing for the identification of changes to the brain that may cause epilepsy.
• Functional MRI (fMRI) - Creating images of the brain that record the flow of blood when specific parts of the brain are not in use, it can be used before surgery to determine the exact locations of critical functions in the brain to assess eligibility and the course of surgery.
• Positron emission tomography (PET) - Using a combination of x-rays and a small, safe amount of radioactive substance, PET identifies areas of the brain with abnormal glucose metabolism, which can indicate where seizures develop in partial seizures.
• Single-photon emission computerized tomography (SPECT) - Used to detect the area of seizure onset in the brain by measuring blood flow in order to assist doctors in planning epilepsy surgery.
• Wada Testing - Used to identify if a patient is a candidate for surgery by identifying the side of the brain controlling language.

Treatment

Dr. Lerman provides a care-comprehensive approach in treatment for epilepsy focused on lessening its symptoms and impacts. He aims to minimize the side effects of medication and significantly improve quality of life of his patients, enabling them to take part in normal day-to-day activities with the ultimate goal of becoming seizure-free.

Careful attention in diagnosis allows him to evaluate and define the best approach to treatment for each patient, which may cover surgical and non-surgical options, including as medication, neuropsychiatric evaluations or the treatment of underlying mood disorders.

Surgical procedures

The effectiveness of surgery is dramatically increasing and it can potentially cure epilepsy when it is possible to localize where in the brain seizures originate. Dr. Lerman provides diagnosis and pre-surgical work-up for eligible patients.

• Laser ablation surgery is a quick and effective one-day procedure performed by a neurosurgeon for those with focal epilepsy. Dr. Lerman identifies those patients that are candidates and locates the areas in the brain to be treated during surgery.
• Vagus Nerve Stimulation (VNS) is a palliative surgery used to prevent seizures and help to reduce seizure burden in patients with medically refractory multifocal and generalized seizure disorders.
• Responsive neurostimulation (RNS) is an innovative and much needed therapeutic option for those with refractory seizures arising from more than one brain region or from those that cannot be removed with surgery. In some patients, it can prove more effective than medication. No brain tissue is removed during the procedure, instead a pacemaker-sized device is inserted under the skull. Attached to two electrodes, it senses and delivers a pulse to stop seizures before they escalate. Dr. Lerman began work with RNS at New York University’s Langone Medical Center and is slated to begin building an RNS program at Baptist Health in Miami.

Medication

Medication can control seizures for seven out of ten people. There are now over 30 available treatments thanks to significant and continuing advances in epilepsy medication, giving practitioners greater choice in matching medications to patient preferences and needs. This optimization is possible with the advent of highly effective medications with minimized side effects, less drug-on drug-interaction, improved tolerability and efficacy.

• Medical cannabis: Cannabidiols (CBD) have shown anecdotal promise in treating medically-refractory epilepsy, those cases that do not respond to conventional medication, allowing patients to benefit from the therapeutic benefits of low-THC cannabis without experiencing any psychoactive effects.

Having first had contact with treatment during his fellowship at New York University’s Langone Medical Center with epilepsy patients suffering from issues related to spasticity, pain and behavioral disorders, Dr. Lerman is experienced in cannabidiols and correct and accurate dosages.

He will be cautiously proceeding in recommending the use of medical cannabis for appropriate candidates, applying a conservative, methodical and medical approach in assessing the eligibility of patients. Patients must be enrolled in the Florida State Department of Health’s Compassionate Care Act. On November 8th 2016, Amendment 2 was passed in the state of Florida which legalized the recommendation of Medical Cannabis for more indications. However, guidelines have not been published as of yet.

• Dr. Lerman will continue to monitor the status of new policies and practice accordingly.

Dietary therapy

Prescription and monitoring of the ketogenic diet. This low-carbohydrate, high fat diet has been shown to help control seizures in some patients, particularly when used in conjunction with epilepsy medication.

Support and education

Information for patients and their families on how to manage epilepsy.