Seizures

Very simply, a seizure is a clinical event resulting from abnormal electrical activity in the brain. The brain cells become overactive and emit increased electrical signals.

When most people hear the word “seizure,” they think about a person having a large, dramatic, full body convulsion. While these types of convulsions can occasionally occur, the majority of seizures do not actually result in convulsions. There are many, many different types of seizures. In fact, there are an infinite number of possibilities. Therefore, we typically classify seizures into a few different types.

We typically refer to seizures as either “simple” or “complex.”

If there is any loss of consciousness, loss of awareness, or confusion associated with a seizure, then it is referred to as a complex seizure.

If the person having the seizure maintains complete awareness and never loses any of their mental faculties, then the seizure is referred to as simple seizure.

We also describe seizures as “general” or “partial.”

If a person has a generalized seizure, that means that their entire brain is suffering from the seizure.

A partial seizure occurs when only one part of the brain is suffering from the seizure.

Using this naming system, we can say that someone had a “complex-partial” seizure which means that the seizure activity only affected a part of the brain but also resulted in an alteration of consciousness. This is actually the most common type of seizure. Often times, there are no outward signs of seizure other than confusion or loss of awareness. These seizures can be very difficult to diagnose and, thus, require the skills of a good neurologist to make an accurate diagnosis. These seizures are commonly misdiagnosed as a “TIA” (but that’s another subject for another day).

Likewise, a person could have a “simple-partial” seizure that results in neurological dysfunction depending on the area of the brain affected by the seizure. For example, if the seizure happens in the area of the brain that controls arm movements, then a person could have shaking of the arm. If the simple partial seizure occurs in the area of the brain that controls sensation in the foot, then a person could have tingling or buzzing in the foot. A simple partial seizure could happen in the area of the brain that controls language which would result in a person being unable to talk or understand.

As you can see, seizures are very complicated clinical entities and I have only just scratched the surface of all the things that must be considered when evaluating a patient for seizure. Seizures can confuse and bewilder even very skilled doctors leading to misdiagnosis. This is why all patients with seizures should be evaluated by a neurologist that has been trained in the diagnosis and treatment of seizures. If you have any further questions, please feel free to contact my office.

EEG

EEG stands for electroencephalogram. It is a medical test that measures brain waves. Electrodes are placed on the scalp and the small amounts of electricity emitted by the brain is recorded.

EEGs are extremely useful tests for a neurologists. We use them mostly for patients that have seizures. However, we use them for many other reasons, too.

Sometimes, patients can have altered levels of consciousness due to other medical conditions. We call this “encephalopathy.” Encephalopathy literally means that there is a problem with the brain. It is a very non-specific term but we use it to describe patients that suffer from confusion, altered attention, and/or drowsiness. EEGs can show that the brain waves are slower than normal. It can also detect whether or not the encephalopathy is due to complex-partial seizures.

We can also use EEGs for patients that suffer from intermittent dizziness. Sometimes, episodic dizziness can be due to very brief, temporal lobe seizures without any other manifestations. This is not very common because most cases of dizziness are NOT due to temporal lobe seizures. However, we will often use an EEG to help us rule our temporal lobe seizures in dizzy patients.

EEGs are mostly used in the prognosis and diagnosis of seizures and epilepsy. They are very important because they help us understand why a patient is having seizures. When we understand what type of epilepsy a patient is suffering from, we can more carefully target treatments. We are typically not trying to capture a seizure on EEG (with a few exceptions). The likelihood of a patient having a seizure while hooked up to EEG is very slim. We are typically looking for certain characteristic waveforms, or signatures, that are emitted from the brain. These tell us why a patient has seizures and from what type of epilepsy they suffer.

We have several different types of EEGs. There are routine EEGs, sleep-deprived EEGs, prolonged EEGs, overnight EEGs, video EEGs, ambulatory EEGs, and several others.

Routine EEGs last about 20-30 minutes. They are almost always the first step in the diagnostic workup for epilepsy and seizures.

A sleep-deprived EEG is usually the next step. It is very helpful because sleep deprivation is very activating for the signature waveforms that give us the information necessary to make a diagnosis.

Prolonged EEGs, overnight EEGs, video EEGs, and ambulatory EEGs are utilized when an extended amount of EEG data is warranted. Sometimes, we are attempting to capture a seizure while hooked up to EEG. But, usually, we just need a prolonged amount of EEG data in order to make a proper diagnosis.

In my clinic, we are capable of performing all the different types of EEG listed above. I personally read and interpret every single EEG performed on my patients. I spend hours every day examining EEG data in order to ensure that my patients receive proper diagnosis and treatment. If you have any further questions about EEGs, please contact my office.

Stroke

The term “stroke” is actually a very broad term. A stroke occurs when there is a problem with a blood vessel in the vein. This includes a number of different events including loss of blood flow (ischemia), bleeding (hemorrhage), and the inability for blood to drain properly (venous thrombosis).

The most common type of stroke, and the type most people are referencing when they say “stroke,” is an ischemic stroke. This is also known as a cerebral infarction. Cerebral means brain and infarction means tissue death due to lack of blood flow. This type of stroke happens when a part of the brain doesn’t get enough blood flow. There are many, many ways this can happen but that topic deserves its own dedicated post. When a part of the brain goes without blood flow, the brain cells in that region can die. The area of the brain that dies is called a “stroke” or “infarction.”

Another fairly common type of stroke is known as an intracerebral hemorrhage. This is when a blood vessel ruptures inside the brain and causes bleeding inside the brain tissue. This bleeding is toxic to the brain cells and can cause them to die. The sheer mass and volume of the blood inside the brain can have devastating consequences and, in the most extreme cases, can cause brain death from brain herniation.

There is also a type of stroke known as a subarachnoid hemorrhage which is when a blood vessel ruptures and causes bleeding AROUND the brain, as opposed to inside of the brain. For a lot of reasons, this is actually one of the most deadly types of stroke.

There are other types of bleeding in the brain too, but these are generally not classified as strokes because they are the direct result of trauma to the head. These include subdural hematoma and epidural hematoma.

Another, less common type of stroke is called a cerebral vein thrombosis. It’s a very unusual stroke syndrome and most neurologists, including myself, don’t really think of it as a “stroke.” This happens when a vein that typically drains blood away from the brain becomes clogged because a blood clot has formed. This usually does not result in brain tissue death which is why most neurologists don’t consider it a “stroke.” However, if the blood flow problem continues without treatment for a prolonged period of time, an area of the brain may die resulting in a “venous infarction.” If this happens, then it is inarguably a stroke.

In the end, all of these stroke syndromes have very specific treatments. Furthermore, the most important aspect of treatment is finding out WHY the stroke happened in the first place. Once a cause can be found, it can be treated and/or reversed so that further strokes will not occur. There are hundreds of reasons why these stroke syndromes could occur and only a neurologist who has been highly trained in stroke has the knowledge to properly diagnose and treat stroke.

If anyone you know has been affected by stroke, please ensure that they were treated by a stroke-trained neurologist and that the specific causative agent for the stroke was found. If not, please set up a consultation with your local neurologist or call my office for an appointment.

Neuropathy

Tingling, numbness, burning, electic-like pain, even weakness can all be symptoms of neuropathy. Strictly speaking, “neuropathy” literally means “problem with the nerves.” It is actually a very broad, general statement. In its purest form, it can mean so many things. But typically, when people and doctors say “neuropathy,” they are actually referencing something called “polyneuropathy.” Poly- means “many.” So, “polyneuropathy” means that MANY nerves have a problem. This implies a that a larger, holistic problem is at play. Something is creating a problem with many nerves in the body.

When we describe polyneuropathies, we use lots of different descriptions to help us understand what TYPE of neuropathy is at work. For example, the most important differentiation that dramatically affects the next step in treatment, is to determine whether a neuropathy is “demyelinating” or “axonal.”

The best way to understand the difference between demyelinating neuropathy and axonal neuropathy is to think of nerves like electrical cables. In essence, this really is how they function. Take a typical electrical wire, for example. The wire has a layer of rubber or plastic coating around it to act as insulation. Underneath all the insulation, is a copper wire. Regarding the nerves, the rubber coating is called the “myelin” and the copper wire is called the “axon.” Demyelinating neuropathies have a problem with the rubber coating while axonal neuropathies have a problem with the copper wire.

In order to discover whether a neuropathy is axonal or demyelinating, a nerve conduction study (NCS) with needle electromyogram (EMG) will need to be performed. Once a NCS/EMG is performed, we can add further descriptive terms to the neuropathy to help understand the cause and treatment. For example, “length-dependent” would mean that the neuropathy is mainly affecting the longer nerves in the body such as the ones for the feet. “Large-fiber” would imply that the larger neurons are noticeably affected. “Autonomic” would mean that the nerves that control vital systems such as blood pressure, heart, and lung function are affected. “Symmetric” or “asymmetric” implies whether the neuropathy is affecting both sides equally. “Sensory,” “motor,” or “sensorimotor” explains whether the sensory and/or motor nerves are affected.

Most neuropathies can be easily treated to at least prevent progression, if not reverse altogether, if the type of neuropathy and causative agent can be identified.

Please see your doctor if you are suffering from neuropathy or call Dr. McCoy’s office to schedule an appointment. He is extensively trained in the diagnosis and treatment of neuropathy.

Neurologists in Oklahoma

If you’ve been looking for a neurologist in Oklahoma, you’ve probably learned that there aren’t many of us. Chances are, if you are looking for a neurologist, you have a disease or medical problem that is scary or difficult to solve. Neurologists, in general, have become the last great diagnosticians (people who diagnose, or solve, medical mysteries).

Instead of trying to navigate a large hospital system like Integris, OU, or St. Francis, I suggest that you entertain an alternative solution.  Consider seeking out an independent physician that isn’t associated with one of these large conglomerates. You may be better off. Independent physicians have resisted the large corporations silently gobbling up smaller, independent practices. Although independent physicians struggle to make a living these days, they have resisted the silent take-over because they believe that the patient-physician relationship is a sacred one that should not be governed by a large corporation. You may receive better care because you aren’t just a number in the system. You also have the luxury of speaking with the OWNER of the company at every meeting. Try it for yourself. It’s a much better experience.

Neurologists are already a rare breed. Narrowing it down to independent physicians even further limits your choices. While rare, they certainly exist.

My life’s dream has always been to own my own medical practice but many have said that it can’t be done in our current post-Obamacare climate. They say it’s not viable and too old fashioned. Solo medical practices are failing all over the country and are being purchased by large multinational health care companies who buy, sell, and trade physicians like commodities. I believe that this is bad for patients, doctors, and our country. So, I’m resisting.

When you come see Dr. McCoy, know that you will be seeing a true solo physician and not a paid-by-the-hour “doctor” who is under the thumb of a suit-wearing business executive cracking the whip. I will be a slave to nothing except for the doctor-patient relationship which I hold in the highest regard. It’s a relationship above all other relationships but has unfortunately lost its luster over the years. Let’s bring it back. There’s a lot of talk about reducing the cost of health care. So let’s eliminate all the fluff, middle men, beuracrats, and lawyers and return medicine to what it always should have been.

It’s so simple: a patient; a doctor; making healthcare decisions together.

I often look to quotes from old movies for inspiration and motivation:
“Nobody thinks it will work, do they?”
“No. But you just described every great success story.”
-quote from Say Anything