It can strike without warning – a sudden loss of awareness, a blank stare, or full-body convulsions that last only seconds but leave lasting questions. For millions of people, these episodes are not isolated events, but part of a chronic neurological condition known as epilepsy. “Epilepsy is an abnormal functioning part of the brain,” said Dr. Oszkar Szentirmai, a neurosurgeon with HCA Florida Lawnwood Hospital. “The brain is a supercomputer, so all those little cells called neurons keep firing and communicating through electrical signals. There’s a certain rhythm to that firing, and like a symphony, if the instruments are off, it’s an unpleasant experience. Similarly, when these neurons misfire, that unprovoked activity creates seizures.” At its core, epilepsy is a disorder of the brain’s electrical system. Nerve cells communicate through carefully coordinated signals, but in people with epilepsy, that coordination can break down, triggering a sudden surge of abnormal activity called a seizure. These episodes can range from subtle lapses in attention to full-body convulsions, depending on which part of the brain is affected. While the condition can be frightening, epilepsy is far more common and often more manageable than many people realize. According to the CDC, nearly 3 million adults and more than 450,000 children in the United States are living with active epilepsy, representing about 1 percent of the population. Globally, the World Health Organization estimates that roughly 50 million people are affected, making epilepsy one of the most prevalent neurological disorders worldwide. In Florida alone, more than 170,000 residents are estimated to have active epilepsy. The causes of epilepsy are not always clear, but the condition generally falls into several categories – structural, genetic, infectious or metabolic. Head injuries, strokes, brain tumors and infections such as meningitis all can trigger seizures. In some cases, complications before or during birth, such as lack of oxygen or developmental abnormalities play a role. Genetics can also increase susceptibility in certain individuals. Despite its complexity, treatment for epilepsy has advanced significantly, offering more hope and control for many patients. The first line of defense is typically anti-seizure medication designed to stabilize electrical activity in the brain. These medications are highly effective; in fact, up to 70 percent of people with epilepsy can become seizure-free with proper treatment. However, not all patients respond to medication. In the United States, more than a million adults continue to experience uncontrolled seizures despite treatment. “About two-thirds of patients with epilepsy can control seizures with medication, but the remaining third are resistant,” Dr. Szentirmai explained. “Those who have refractory, or drug-resistant, seizures should be evaluated quickly by a neurosurgeon. Scientific data show that the longer you wait to identify those who don’t have proper seizure control medically, the higher the risk of permanent brain damage.” In children, ongoing seizures can interfere with learning and development. In adults, the condition can lead to long-term disability and a diminished quality of life. Even for those patients, though, other options are available and increasingly effective. Surgical intervention can be life-changing, particularly when seizures originate from a specific area of the brain that can be safely targeted. And thanks to rapidly evolving technology, these procedures have become far less invasive than in the past. “Surgical approaches to the brain have drastically improved over the past decade,” Dr. Szentirmai said. “Before, surgeons had to open the skull to place grids to identify the source of the seizure. Now we can place very thin electrical wires through a tiny, 2-millimeter hole in the skull. It’s like looking through a keyhole and seeing the whole room. With robotic guidance, it’s like a GPS and we can pinpoint the exact source.” Once that source is identified, surgeons can remove the problematic tissue or use laser ablation to destroy the area causing abnormal electrical activity, all while preserving surrounding healthy brain function. Other advanced treatments include implantable devices such as vagus nerve stimulators, which send electrical impulses to help regulate brain activity, and responsive neurostimulation systems that can detect and interrupt seizures before they fully develop. In some cases, surgeons may also disconnect certain brain pathways to reduce seizure frequency and severity. “Our goal is to preserve function and avoid harming normal brain tissue while addressing the problematic area,” Dr. Szentirmai said. “With these newer technologies, recovery is much faster. Many procedures are minimally invasive, with patients often going home the next day and returning to their lives more quickly.” Beyond medicine and surgical treatments, lifestyle adjustments can also play a key role in managing epilepsy. Lack of sleep, stress, alcohol use, and even flashing lights can trigger seizures in some individuals. Identifying and avoiding these triggers is often an important part of a comprehensive care plan. It’s also important to recognize that not all seizures are visible. Some, known as subclinical seizures, may occur without obvious physical symptoms but still affect brain function. “We’ve found that nearly half of patients with Alzheimer’s disease may have subclinical seizures,” Dr. Szentirmai noted. “Overall health monitoring should include not just monitoring cholesterol, blood pressure and blood sugar, but also neuropsychological testing, especially in the aging population. This can be done with an EEG.” Emerging technologies are also expanding the possibilities for care, including implantable devices that continuously monitor brain activity and respond in real time to prevent seizures. New imaging models on the horizon promise even more precise diagnosis and treatment. Still, Dr. Szentirmai emphasizes that timing is critical. “The problem is that many patients stay on medications for too long, even when they’re ineffective or causing significant side effects, which impacts quality of life,” he said. “The sooner we identify those who may benefit from surgical intervention, the sooner they have a chance to live a normal life.” In the end, awareness and access to care remain key. Because while seizures may be unpredictable, the path forward doesn’t have to be. Dr. Oszkar Szentirmai graduated from Semmelweis University and completed his neurological surgery residency at the University of Colorado. He then pursued fellowships at Massachusetts General Hospital/Harvard and New York Presbyterian Hospital/Cornell specializing in brain tumor treatments and skull base surgery. His office is located at HCA Florida Neurosurgical Specialists-Lawnwood, 2401 Frist Boulevard, Suite 6, Fort Pierce. Call 772-241-6720 for an appointment.