Disorders neurology and epileptology
Symptoms of epilepsy include seizures, sometimes without but often with partial or complete unconsciousness.
The range of seizure symptoms comprises:
- the aura (only the patient discerns a pre-sensation of a seizure)
- seizures with a stare, no reaction to communication and stereotypical motion of the mouth or hand (complex and focal)
- generalized seizures with convulsions of the whole body, discoloration of the head from normal to blue (grand mal)
The duration of epileptic seizures varies from some seconds to several minutes, averaging 30 seconds to 2 minutes. Seizures are subdivided into focal or generalized seizures, epileptic syndromes or hybrids.
Often patients also suffer from a disturbance of the mental state, memory retention and concentration as well as a depressive mood or anxiety disorder.
Social consequences: A Patient´s quality of life is not only affected by the seizure itself but also by its impacts on daily life. This makes a special counseling necessary, which covers a variety of topics. Being diagnosed with epilepsy, often has far-reaching consequences: career choices may be limited, mobility and driving a car is restricted/not possible, and giving birth to a child has to be planned beforehand due to epilepsy medication.
There are various causes of epilepsy, e.g., hereditary, genetic-related damage of the brain or syndromes, disorders of the cerebral metabolism, acquired cerebral malformations, brain tumors, inflammation of the brain, damage of brain-supplying blood vessels, apoplectic stroke, head trauma, head injuries caused by concussion or traumatic brain injury, etc.
High-definition MRI of the brain (1.5-3 tesla)
It is difficult to imagine diagnosing epilepsy without this diagnostic tool nowadays. Magnet resonance imaging creates images by using magnetic fields. This graphical representation of the brain has a significantly higher resolution and a better contrast between grey and white matter than computed tomography. Given specific questions, especially planning surgery, functional magnetic resonance imaging (fMRI) is possible in order to match specific functions of the brain to certain areas of the brain. Follow-up examinations are often advised once a year or more often in case of epilepsy. By now, 3 tesla MRI is the state-of-the-art diagnostic tool for epilepsy that only merely responds to treatment.
EEG/electroencephalography: routine, long-term, sleep deprivation, inpatient video EEG monitoring
Electroencephalography can directly show the tendency of the brain to suffer an epileptic discharges. During EEG, a nurse or a doctor attaches electrodes to the patient´s scalp, which receive electrical impulses from the cerebral cortex. If epilepsy is suspected, a routine EEG provokes epilepsy by hyperventilation and flickering lights.
Within the scope of first diagnostics, EEG serves to localize the focal region in the brain that causes epilepsy in case of focal seizures. Specific questions also may require long-term EEG (e.g., 24 hours), EEG during sleep deprivation or EEG with simultaneous video recording.
An early EEG after an epileptic seizure enables the neurologist to see changes in the wavelengths of the brain, localized slow-downs or waves typical for a certain kind of epilepsy.
Cerebrospinal fluid diagnostics
In order to validate a certain kind of epilepsy, a so-called grand mal epilepsy (convulsions of the whole body, discoloration of the head from normal to blue), several blood levels are examined (creatine kinase, prolactin). Regular blood test are also indispensable because epilepsy medication can have an effect on liver and kidneys. In addition, blood diagnostics also reveal if the medication is taken regularly.
Cerebrospinal fluid examination
A lumbar puncture with an examination of the cerebrospinal fluid (fluid from brain, spinal cord) is carried out in case of a presumptive inflammation (e.g., inflammation of the brain) but also in case of epileptic seizures, which could not be successfully treated by drugs, or other complaints like amnesia or depression.
Diminished memory function or concentration as well as the impact of epilepsy on the daily life can be detected and controlled over time.
There are more than 20 types of medication to treat epileptic seizures, but not every one of them is suitable and efficient to treat every kind of epilepsy. Some drugs, e.g., carbamazepine, can worsen specific types of the generalized epilepsy. Owing to these circumstances, a careful selection of medication is crucial. Especially particular groups of patients like pregnant women, elderly people or children need a special check that estimates the tolerance, side effects and interaction between different drugs. Choosing the right medication for these patients is very restricted and requires a comprehensive clarification.
Neurostimulation/vagus nerve stimulation (VNS)
Direct vagus nerve stimulation (VNS)
Direct vagus nerve stimulation (VNS) is the most common type of neurostimulation. It is based on the regular stimulation of the left vagus nerve via an implanted generator located beneath the left collarbone that gives an electric impulse every 5 minutes and 30 seconds. This impulse is transferred to the brain, where the epileptic activity is suppressed locally.
The direct vagus nerve stimulation has been established for more than 20 years and has yielded good results given severely affected patients. However, magnet resonance imaging or the brain can only be performed with restrictions due to the implant. Long-term studies have proven that more than half of the patients have experienced a significant improvement of more than 50%. Data also suggests that the quality of life and the mood have been better as well as attention and motor functions.
Deep brain stimulation
Deep brain stimulation (DBS) is a treatment option that has only been available for epilepsy therapy for the last years. During surgery, electrodes are implanted into the brain and placed in specific areas, regularly transmitting electric impulses and, thus, improving the condition of epilepsy patients.
Given severe epilepsy resistant to medication, epilepsy surgery has to be considered. During hospitalization, it is examined whether epilepsy surgery is possible, which chances of cure or improvement of the symptoms may be realistic and also which risks (language/speech disorder, paralysis, etc.).
The number of epilepsy surgeries in Germany per year is not very high, and only specialized epilepsy/neurosurgery centers, which should have at least 25 brain surgeries a year, should perform this kind of surgery.
Other treatment options
There are several other options to treat epilepsy subject to specific conditions: ketogenic diet (fatty but only few carbohydrates and proteins), biofeedback, perceived self-control of epileptic seizures and transcutaneous vagus nerve stimulation (t-VNS).
Patients receive certain kinds of stimuli, whose reactions in the body are measured during biofeedback. Patients learn during exercises how to counteract undesired reactions of the body, e.g., by influencing their own breathing, heartbeat, tension/relaxation. If the reaction they are hoping for happens, they will get a feedback via monitor, speakers or headphones.
Perceived self-control of epileptic seizures
Much like biofeedback, patients learn to react to factors and patterns causing an epileptic seizure in order to prevent it, by performing perceived self-control of epileptic seizures.
Transcutaneous vagus nerve stimulation (t-VNS)
Two different types of vagus nerve stimulation (VNS) serve as a treatment of epilepsy. The direct vagus nerve stimulation works with an implanted impulse device, whereas the transcutaneous vagus nerve stimulation (t-VNS) utilizes an external impulse device. Transcutaneous means via the skin. Thus, the electrode is placed onto the skin of an ear and transmits electric signals from there.
First seizure clinic
We offer you a “first seizure service“ that can help you sustain a good quality of life and may even prevent the disorder from advancing or worsening.
Teamwork at the First Seizure Clinic
Epilepsy is a common neurological disease. About one percent of the population suffers from it. One person out of every 10 has an epileptic attack at least once in his/her lifetime.
Epilepsy, however, entails more than just seizures. Many patients can be treated with immediate effect and no longer suffer from seizures after the first drug treatment. However, some patients seem to have a different pathomechanism or an entirely different disease.
Despite medicinal treatment, these patients continue to suffer from (drug-resistant) seizures, which often include psychiatric disorders, cognitive deficits, behavioural problems and metabolic disorders. For a long time, these phenomena were thought to be epilepsy, and medicinal anticonvulsive treatment was at the heart of therapy. Research over the last few decades has almost exclusively focused on severely affected epilepsy patients and pursued a goal of seizure suppression. This approach is currently being reconsidered. There is growing evidence that specific neurobiological mechanisms are responsible for the development of neurological and behavioural problems.
In order to make the management of seizures effective for patients, in addition to the treatment of seizures, accompanying diseases must also be treated early, sufficiently and attentively.
As a component of our “First Seizure Clinic” concept, we effectively treat seizures as well as neurological, cardiological, internal and psychiatric disorders at early stages. In collaboration with our cardiological, neuropsychological, neurosurgical, epidemiological, genetics-oriented, neuroradiological, psychiatric and psychosomatic colleagues, we are attempting to broaden this new focus on the disease.
The Beta Klinik represents a suitable platform that meets our cooperation requirements across the above-mentioned specialty fields.
Our goal is to provide patients with a range of diagnostic tools at an early stage, thereby enabling, at the onset of potentially chronic diseases, the identification of causes, effective treatment and early intervention, in order to improve patient quality of life and to counter psychosocial impact (driving ban, professional decline).
Teamwork in cases of dementia
Dementia is feared by the general populace. Many patients are concerned that they might be suffering from dementia.
We look after patients with tentative diagnoses in a neurological-general medical setting. This includes the use of special, high-resolution magnetic resonance imaging (MRI), EEG, neuropsychological tests and ergotherapy.
However, more complex issues should be referred to specialized outpatient clinics operated by university hospitals.
Headaches and migraines
A tension headache is the most common type of headache, but it is often dismissed by patients as a simple “headache”. Medical assistance is not sought. Together with migraines, tension headaches cause 90 percent of all headaches. Tension headaches affect the entire head, causing it to feel as though it is being squeezed by a helmet. Scientists suspect that pain processing of the brain is altered. While medication is used to mitigate acute pain, chronic tension headaches should also be treated prophylactically, similarly to chronic migraines. The drugs are individually adjusted in accordance with each patient’s individual requirement.
A migraine is a neurological disorder that affects 10 to 15 percent of the population. It occurs in women approximately three times more frequently than in men and has various disease patterns. In adults, it is typically characterized by a periodically recurring, acute, pulsating and one-sided headache, which may be accompanied by nausea, vomiting, light sensitivity or noise sensitivity. In some patients, a migraine attack is preceded by an aura, with visual or acoustic perceptual disturbances.
Causes: Serotonin metabolism of the brain is often altered in migraine patients, causing the blood vessels of the brain to become irritated and more permeable to certain pain molecules.
“Sterile” neurovascular inflammation and pain occur. Studies have shown that the CGRP (calcitonin gene-related peptide) neurotransmitter is increased in the blood of many migraine patients. It plays a role in the transmission of pain. Another causal theory involves the hyperexcitability of nerve cells in the brain.
Symptoms: A migraine often manifests itself via a combination of headache, nausea as well as light and noise sensitivity. There is usually a great need for rest. Chronic migraine is referred to as the occurrence of 15 headache days per month, of which 7 to 10 days feature migraine headaches, over a period of at least three months.
Treatment: There are numerous drugs that can help relieve migraines. A distinction is made between drugs that help in acute cases, such as triptans, and those that are taken on a daily basis (prophylactics) reduce the frequency and intensity of attacks.
Headaches triggered by painkillers
Headaches are an almost everyday ailment for Germans and are often dismissed. Random drugs are taken too frequently. If they fail to produce the desired effect, they are often supplemented with combination products. In the long term, this considerably deteriorates the pain situation.
Cervicogenic headaches: A cervicogenic headache is referenced when the cause is located in the region of the upper cervical spine (head joints). These headaches usually result in one-sided pain, begin in the back area of the head and radiate either to the forehead or laterally, via the ear to the face.
Patients are between the ages of 20 and 30 or are over 50 years old. Particularly in younger patients, imaging methods, such as X-ray and magnetic resonance imaging, often show normal findings. Patients have often gone through many years of therapeutical odyssey. While in older patients, degenerative changes (arthrosis) in the joints of the upper cervical spine are often the root cause, no immediate cause can often be found in younger patients. However, in 50 to 70 percent of these patients, accidents dating back many years (rear-impact crashes, falls during sports) are often detected.
A diagnosis can be confirmed by means of fluoroscopy or CT-guided injections of a local anaesthetic into the C2-3 joint or the third occipital nerve, more rarely, into the C1-2 and C3-4 joints as well.
Very good therapeutic results are obtained via radiofrequency denervation (sclerotherapy) of the affected joints/nerve branches. This is a minimally invasive procedure, whose mode of operation has been known for decades and has been thoroughly investigated by numerous studies.
Members of the Beta Klinik orthopaedic team work in close cooperation with each other.
Meningitis is an inflammation of the dura mater and/or spinal cord skin (meninges).
Viral meningitis is the most common form as bacterial meningitis occurs much less frequently. Causes include viruses, bacteria (pneumococci, meningococci) and fungi. If the disease attacks the brain, it is called meningoencephalitis.
Early indications include flu-like symptoms, such as high fever and headaches. In addition to these non-specific complaints, neck stiffness or exanthema should be considered warning signs. Viral meningitis cannot be distinguished from bacterial meningitis in the initial stages, but viral meningitis is usually milder.
A neurological examination, magnetic resonance imaging of the head and a lumbar puncture are indispensable for diagnosis. Antibiotic therapy or treatment with so-called virostatic agents work seamlessly. It is often necessary to administer infusions several times a day, so in-patient stays are required. The Beta Klinik’s modern facilities and our interdisciplinary ward team ensure that you will be treated in a comprehensive, competent and caring manner.