Dr. Douglas R. Nordli III, a 2018 graduate of the Doctor of Medicine (MD) program at the American University of the Caribbean School of Medicine (AUC), will soon wrap up his epilepsy fellowship at the University of Chicago Department of Neurology. The program emphasizes comprehensive diagnostic evaluation and treatment of patients with epilepsy. Before that, Dr. Nordli completed the Child and Adolescent Neurology Residency at the Mayo Clinic Florida. Today, we’re tapping into Dr. Nordli’s expertise to learn about epilepsy as well as the basics of pediatric neurology. Epilepsy is the fourth most common neurological disorder in the world, and just one of the many neurological diseases that affect children and adolescents.
Q: First, Dr. Nordli, what exactly is epilepsy?
A: Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures or by a single seizure with a significant risk of experiencing further seizures if left untreated.
Q: How are different kinds of epilepsy classified?
A: The classification of epilepsy is inherently complex, as it significantly influences treatment approaches and prognosis. Generally, epilepsy can be classified into two main categories: focal, where seizures occur in one part or hemisphere of the brain, and generalized, where seizures affect the entire brain.
Q: What are seizures and the triggers that may cause them?
A: Seizures are characterized by sudden surges of abnormal electrical activity in the brain, leading to clinical changes. Triggers can vary widely among patients. Common causes of acute symptomatic seizures include traumatic brain injury, cerebrovascular disease, and infections.
Q: What are seizure emergencies and thresholds?
A: In general, a seizure lasting five minutes or more constitutes an emergency. Seizures persisting beyond this timeframe have the potential to become medication resistant and life threatening. Many patients with epilepsy have rescue medications to manage such situations.
Q: How do people prepare, manage, and respond to seizures? Are there specific challenges to living with epilepsy?
A: People manage and respond to seizures in varied ways. The experience of seizures and the diagnosis of epilepsy can be highly challenging. Unlike conditions with overt manifestations, such as orthopedic injuries with visible casts, epilepsy often lacks external signs. Consequently, its presence is less conspicuous. Effective epilepsy management typically necessitates consistent medication adherence, often requiring twice-daily dosing. Individuals and their caregivers frequently express the apprehension of seizures occurring unpredictably, significantly disrupting daily life. Those grappling with drug-resistant epilepsy, marked by the failure of two appropriately selected medications, face heightened risks. Medical studies underscore that drug-resistant epilepsy profoundly alters the quality of life for affected individuals.
Q: What can you tell us about Sudden Unexpected Death in Epilepsy (SUDEP)?
A: SUDEP stands as a poignant and formidable complication of epilepsy. Despite ongoing research efforts, its mechanisms remain inadequately understood, although likely related to seizures inducing dysfunction in vital signs. Annually, SUDEP affects approximately 1 in 1,000 adults with epilepsy and 1 in 4,500 children with epilepsy. Major risk factors include poorly controlled seizures and inadequate medication adherence, underscoring the pivotal roles of accurate diagnosis and strong patient rapport in mitigating this serious outcome.
Q: What are some common misconceptions of epilepsy and the people who suffer from it?
A: Numerous misconceptions surround epilepsy. Firstly, it's crucial to clarify that epilepsy is not a mental illness. Furthermore, epilepsy manifests differently in each individual, highlighting its heterogeneity. Importantly, a diagnosis of epilepsy is not a sentence of hopelessness. Accurate diagnosis, personalized treatment strategies and modern technology hold the promise of improving remission and cure rates in people with epilepsy.
Q: How does childhood epilepsy differ from the disorder in adults?
A: Epilepsy typically emerges in one of two distinct age brackets: either before the age of 20 or after the age of 65. My primary attention is directed towards individuals whose epilepsy initiates during their early years, as this demographic faces particularly formidable challenges. Successful treatment can profoundly alter the trajectory of lives for the better.
Q: How is epilepsy diagnosed and treated — in both children and adults?
A: An electroencephalogram (EEG) stands as a fundamental diagnostic tool in the assessment of epilepsy. A comprehensive evaluation entails a detailed patient history and a thorough neurological examination, with careful attention to seizure semiology. This meticulous approach, coupled with a meticulous analysis of EEG findings, facilitates accurate and expedient diagnosis of patients with epilepsy.
Q: What are the different causes of childhood epilepsy? Is there any evidence that immunizations cause epilepsy?
A: Immunizations do not cause epilepsy. Instead, the causes of epilepsy typically stem from factors such as an inherent susceptibility, predominantly influenced by genetics, or structural abnormalities within the brain, which can vary from subtle to significant malformations.
Q: What are the differences between benign and more serious childhood seizures?
A: Certain childhood onset epilepsy syndromes exhibit high rates of remission, often colloquially referred to as children “outgrowing” their epilepsy, with low seizure frequency. Conversely, epileptic encephalopathies are characterized by high rates of intractability, elevated seizure frequency, and an increased risk of associated morbidity and mortality. The seizure types and EEG findings in these conditions manifest distinctive patterns that are discernible, though often necessitating considerable experience and training to interpret accurately.
Q: Thinking back on when you applied to medical school, what steered you toward AUC?
A: I looked up to a highly successful and well-trained neurologist who was a graduate of AUC — Dr. John Millichap.
Q: What are your fondest memories of being an AUC student and living in Sint Maarten, the home of AUC?
A: My most cherished memories revolve around the camaraderie shared with classmates and meeting my wife. The camaraderie among classmates forms lasting friendships and fosters an appreciation for the sacrifices we make to become physicians and serve others. Meeting my wife enabled us to navigate pivotal moments in our professional journey together and forge lifelong connections with each other and fellow AUC graduates.
Q: What motivated you to go into neurology?
A: Watching my father, an epileptologist, at work inspired my passion for neurology. Growing up, I observed the profound impact that he has had on the lives of people with epilepsy. Exposure to EEG from a young age ignited an enduring curiosity that continues to captivate me.
Q: Finally, many current and future medical students will be reading this interview; do you have any words of advice for them?
A: The physician’s ultimate calling is to restore health to the sick — to heal. It's essential to keep a firm grasp on the reasons why you embarked on this journey. Stay introspective, deliberate, and committed in your efforts. Cultivate a grounded sense of self alongside an unwavering work ethic. This combination not only facilitates healing for many but also enables one to lead a profoundly purposeful life.
Thank you, Dr. Nordli, for sharing some valuable neurological insights! To learn more about childhood epilepsy, visit the Epilepsy Foundation, the Childhood Neurology Foundation, and Epilepsy Information for Parents at the United States Centers for Disease Control and Prevention (CDC). The CDC’s About Epilepsy is also an excellent resource, and the Managing Epilepsy Well (MEW) Network is a great place to learn about epilepsy self-management. When November rolls around, check out National Epilepsy Awareness Month to see how to help raise public awareness and reduce the stigmas associated with epilepsy.
At AUC School of Medicine, our students move on to neurology and many other types of medical residencies. Our 2023–2024 MD graduates achieved a 98% first-time residency attainment rate* and are now beginning their post-graduate training across 22 specialties. If a career in medicine interests you, learn more about AUC and our medical sciences curriculum, as well as the requirements for admission.
*First-time residency attainment rate is the percent of students attaining a 2024-25 residency position out of all graduates or expected graduates in 2023-24 who were active applicants in the 2024 NRMP match or who attained a residency position outside the NRMP match.
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