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Dr. Locatelli is Director of Neuroscience and Medical Director of the Epilepsy Program at Holy Cross Hospital. He's a Board Certified Neurologist, Diplomate, American Board of Psychiatry & Neurology; Diplomate, American Board of Clinical Neurophysiology (Special track: Epilepsy Monitoring ); and Neuroimager, American Society of Neuroimaging. Dr. Locatelli serves on the Board of Directors of the Epilepsy Foundation of Florida.

"The quality of life of those diagnosed with epilepsy is affected by their restricted independence, inability to drive, stigma, medication side effects, or depression. Making the correct diagnosis is essential," says Dr. Locatelli.



Download the Epilepsy Monitoring Unit virtual brochure




  • EPILEPSY


  • FACTS ABOUT EPILEPSY
    • About 1% of the population will have seizures in their lifetime
    • 40-60 % of People with persistent seizures or spells do NOT have epilepsy
    • For those with persistent epileptic seizures, brain surgery can cure epilepsy
    • Video-EEG monitoring can help make the correct diagnosis
    • Video-EEG monitoring can help localize the area that may need to be removed to cure epilepsy through surgery
    In order to make the proper diagnosis, these patients require diagnostic procedures in an Epilepsy monitoring unit. The process is as follows: the patient stays in the unit under close supervision, his or her medications are discontinued, and continuous brain wave monitoring is recorded via electroencephalograms (EEGs) and simultaneous digital video to correlate brain activity with convulsive behavior. Through this diagnostic procedure, Dr. Locatelli can ascertain the presence of epilepsy 95% of the time.

    Once the correct diagnosis is made, Dr. Locatelli then decides the appropriate intervention. Medication management and surgery are current treatment modalities. If a patient continues to have seizures after taking three or four medications, the chances of controlling their seizure disorder with an additional medication is less than 5%. In this group that is refractory to medication, the mortality rate can be as high as 1%. About 25% of those evaluated in the unit are potential candidates for surgery, which may offer a cure for epilepsy. Epilepsy surgery can be successful 65 to 90% of the time.

    "Some patients can't be treated with surgery but new treatments are underway," says Dr. Locatelli. Up and coming defibrillator-like devices are expected to sense an imminent seizure and will release an electric shock, preventing the seizure from taking place. These and many more techniques and biotechnology advanced devices will assist Dr. Locatelli in his pursuit of better diagnostic tools and treatment options.


    ABOUT SEIZURES

    Have you or anyone you know experienced a seizure?

    If so, you might be aware of the mystery of when and why they occur. Because the onset of a seizure is often random, it can be quite difficult for those experiencing seizures and their families to enjoy a routine quality of life. Seizures are a symptom of epilepsy, but they can be due to other conditions as well. It is reported that more than 56 percent of people who experience seizures that do not respond to medications and are told that they have epilepsy, actually do not. Conversely, since many people experience seizures in subtle ways, as simple as intermittent tripping, they may not even realize they could have epilepsy. There may be more than 200 symptoms indicative of seizures. Education about the origin of seizures and proper diagnosis is key in order to help you maintain a quality of life. At our new specialized epilepsy monitoring unit located at Holy Cross Hospital, we conduct the most technologically advanced tests to help us determine the origin of seizures, whether they are epilepsy related or due to other circumstances. Our team will evaluate and recommend the best treatment options for each patient. Sometimes, we will need to alter medications; other times when the tests indicate, we can even send some of our patients for brain surgery to remove the affected part of the brain causing the seizures and cure the patient.

    There are many types of seizures. We often visualize seizures as someone falling and shaking uncontrollably, but do you know that seizures may also appear in very mild ways?

    We have seen patients experience seizures in the form of rapid blinking of the eyes, unsteadiness on their feet, visual changes such as distortions in the size and shape of objects, strange smells, or even deja vu. It can sometimes be very difficult to notice the onset of a seizure.

    COMMON TYPES OF SEIZURES

    Why do some people with epilepsy shake uncontrollably and others do not?

    This depends on the area of the brain that is affected. There are several types of seizures each accompanied by varying symptoms. Through the use of new technology, we are better able to identify the exact area of the brain where the seizures are coming from resulting in a more positive treatment outcome for our patients.

    Before your doctor can prescribe the right treatment, proper diagnosis is necessary to determine the type of seizure you have. Typically, seizures are classified into two types, which are determined by how the seizure begins and which parts of the brain are affected.

    The first type, called a generalized seizure, begins with a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures. There are several variations of generalized seizures, which include:

    • Absence seizures, also known as petit mal seizures, cause a short loss of consciousness. The patient will usually stare into space and experience twitching movements of the eye muscles. These periods last for seconds or even tens of seconds. Those experiencing absence seizures sometimes move from one location to another without awareness that they are having a seizure except that they may be aware of lost time.
    • Atonic seizures produce an abrupt loss of muscle tone, particularly in the arms and legs, which often results in a fall. Because they are so abrupt and without any warning, and because the people who experience atonic seizures often fall with force, these seizures have been known to cause injuries to the head and face.
    • Tonic-clonic seizures, formerly known as gran mal seizures, are the most common and dramatic types of seizures and affect the entire brain. During this type of seizure, the patient loses consciousness and usually collapses. Loss of consciousness is followed by generalized body stiffening (called the "tonic" phase of the seizure) then by violent jerking (the "clonic" phase) after which the patient goes into a deep sleep.
    • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects.


    The second type, called a partial seizure, begins with an electrical discharge in one limited area of the brain. Some are related to head injury, brain infection, stroke, or tumor, but in many cases the cause is unknown.

    Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations. In partial seizures, the electrical disturbance is limited to a specific area of one side of the brain. Partial seizures are subdivided into simple partial seizures (in which consciousness is retained) and complex partial seizures (in which consciousness is impaired or lost).

    No matter what type of seizures you have, our team will work with you to properly diagnose and coordinate a treatment plan that will enable the best quality of life possible. Please call or e-mail us to schedule an appointment if you need help understanding and controlling your seizures.

    FREQUENTLY ASKED QUESTIONS ABOUT EPILEPSY

      1. What is epilepsy?
      If you have epilepsy, you are not alone. After Alzheimer's disease and stroke, epilepsy is the third most common neurological disorder in the United States. Normal brain function is made possible by electrical charges passing between nerve cells in the brain and throughout the body. Epilepsy is a condition that causes the brain to produce sudden bursts of electrical energy that disrupt other brain functions. These bursts may affect a person's consciousness, bodily movements, or sensations for one to three minutes. A seizure is a symptom of epilepsy, but not all seizures are caused by epilepsy. In fact, 40 to 60 percent of people with persistent seizures or spells do NOT have epilepsy, which demonstrates the importance of an epilepsy monitoring unit to help your doctor make the correct diagnosis.

      2. What should I do if I witness someone having a seizure?
      Witnessing a person experiencing a seizure can be extremely upsetting especially if it is for the first time. Unless you are familiar with how people behave during seizures, you may not even know what is happening. If you know what to expect, you will be better able to provide proper assistance. It is also very important for people who experience seizures to tell their friends and family what to do if a seizure occurs. Although there is nothing you can do to stop the seizure, there are several simple first aid steps that you can follow to help keep the person safe until the seizure stops naturally. As recommended by the Epilepsy Foundation:

      • Stay calm and reassure other people who may be nearby.
      • Do not hold the person down or try to stop the movements.
      • Time the seizure with your watch.
      • Clear the area around the person of anything hard or sharp to keep them safe.
      • Loosen anything around the neck, such as a tie or shirt button, that may make breathing difficult.
      • Put something flat and soft, like a folded jacket, under the person's head.
      • Turn the person gently onto one side. This will help keep the airway clear.
      • Do not try to force the mouth open with any hard implement or with fingers. It is not true that a person having a seizure can swallow his or her tongue. Efforts to hold the tongue down can injure the teeth or jaw.
      • Do not attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
      • Stay with the person until the seizure ends naturally.
      • Be friendly and reassuring as consciousness returns.
      • Offer to call a taxi, friend, or relative to help the person get home if he or she seems confused or unable to get home by him or herself.


      3. Is it safe for me to have a baby if I have epilepsy?
      Yes. More than 90 percent of women with epilepsy will have normal, healthy infants, and most of them have very normal pregnancies. For women with epilepsy, the idea of becoming pregnant, delivering a healthy baby and being able to independently take care of the baby after birth may be exciting and worrisome. According to the Epilepsy Foundation, there are some increased risks for women with epilepsy that should be considered before getting pregnant. Just like you would visit your obstetrician on a regular basis if you are pregnant, being pregnant with epilepsy may mean more frequent visits to your neurologist. It is highly recommended that you, your neurologist and your gynecologist/obstetrician be involved in reviewing your antiepileptic drug (AED) and any potential medication changes prior to the beginning of a pregnancy. All women should put careful thought and consideration before deciding to have a baby. A woman with epilepsy just needs to put a little more thought and consideration into it with her partner, support system and doctors because she is at greater risk for possible complications of pregnancy, labor and adverse pregnancy outcomes than women who do not have epilepsy. You and your team should focus on your health (nutrition and smoking cessation, for example), reducing your stress and prescribing you the proper medication. Many of our patients are the proud parents of happy, healthy babies! For more information, visit the Epilepsy Foundation Web site.

      4. Is anti-seizure medication safe?
      As with many diseases, finding a drug that helps to best control seizures is a balancing act. At Florida Neuroscience Center, we work together with our patients to try the best drug and dosage based on individual needs. We are always interested in knowing of any symptom and side effect you may be experiencing, whether it is directly related to epilepsy or to medication-adverse effects. The Food and Drug Administration (FDA) recently reviewed the safety of a number of epilepsy drugs. This was a result of a study that showed that the drugs increased patients' risk of suicidal thoughts and behavior. While the FDA advisory panel voted unanimously that 11 antiepileptic drugs (AEDs) could cause suicidal thoughts and behavior, they recently voted NOT to place suicidal warnings on epilepsy drugs. Some of these drugs work very well in controlling seizures for our patients. While the risk of suicide is apparently small, studies suggest that as much as 30 to 50 percent of people experiencing uncontrolled seizures have clinical depression, and if the depression is left untreated, it could elevate the risk of suicide. The Epilepsy Foundation advocates the following for people with epilepsy who take AEDs:

      • Never stop taking or change your medication without talking to your doctor. The risk of a breakthrough seizure and the safety consequences are greater than any other concern or risk.
      • It is normal to feel sad or anxious sometimes; it is just part of living. However, if you find that you are sad for long periods of time and have trouble enjoying life, it could be a serious medical condition called depression. Scientists suspect epilepsy and depression may have a common underlying cause. So talking with your doctor about depression isn't something to be ashamed of - it is a medical condition and usually can be successfully treated.
      • Anytime that you are feeling depressed - whether on a drug involved in this study or not - it is essential that you contact your treating physician as soon as possible.


      5. What is an epilepsy monitoring unit?
      An epilepsy monitoring unit (EMU) is a set of hospital-based rooms with state-of-the-art digital equipment to monitor and assist with the diagnosis of complicated seizure cases. In the EMU at Holy Cross Hospital in Fort Lauderdale, our patients stay in comfortable private rooms in a medically supervised environment. While admitted to the EMU, a patient is connected to an electroencephalograph (EEG) machine via dozens of tiny wires that are taped to the head. Here, we record continuous brain wave activity with simultaneous video recording. Brain waves during or between seizures may show special patterns, which help us decide whether or not someone has epilepsy. Sometimes, a seizure can be induced if it is known what type of stimuli causes it, for example, music or loud noises. Thorough screening is essential for diagnosis and treatment planning because seizures are only a symptom of epilepsy. The tests conducted in an EMU help us locate the portion of a patient's brain where the abnormalities occur. We can identify whether or not a patient is a candidate for brain surgery and be cured of his or her seizures.

      6. Can surgery cure epilepsy?
      Yes. For many patients with persistent epileptic seizures, brain surgery can be a cure. Through video-EEG monitoring that we conduct while patients are admitted to the epilepsy monitoring unit (EMU), we are better able to make a correct diagnosis and localize the area of a patient's brain that may need to be removed to cure epilepsy. Some of our patients have suffered seizures since childhood. Others have started their seizure activity as adults. Regardless of when they started to have seizures, we would admit them to the epilepsy monitoring unit. Through specialized monitoring and a PET scan, in some cases, we would be able to identify the exact location of the abnormalities in the brain and locate the portion of the brain that could be operable. About 25 percent of those evaluated in the EMU are potential candidates for surgery, which can be successful 65 to 90 percent of the time. Patients are usually thrilled about getting a new lease on life and doing things that they were unable to do before, such as pursuing a college degree or starting a career that will help better provide for and take care of their loved ones.

      7. What if I am not a candidate for surgery?
      Some patients cannot be treated with surgery, but new treatments are underway. Soon, defibrillator-like devices are expected to become available. These devices sense an imminent seizure and will release an electric shock, preventing the seizure from taking place. These and many more techniques and biotechnology advanced devices will provide hope to patients who previously could not be helped.

      8. What foods should I be eating to control my seizures?
      For people who suffer from seizures, the importance of taking care of the whole body by paying attention to the psyche, not smoking, exercising, and maintaining a healthy weight cannot be underestimated. For patients who need to lose weight, there is an eating plan that may also help control seizures. Pediatric neurologists and parents have been using the ketogenic diet to control seizures in children for almost 100 years. It appears to limit or even eliminate seizures, possibly by generating the build-up of ketones, which are compounds the body produces when it derives calories mostly from fat. The ketogenic diet often consists of a short period of fasting, strictly limits fluids, and drastically restricts carbohydrates. For adults, this regimen is very difficult and may be detrimental to overall health. We do recommend a modified Atkins diet, which focuses on high protein and low carbohydrates. Most calories come from eggs, meats, and oils. The Johns Hopkins University School of Medicine has conducted research on the modified Atkins diet in adults with seizures, which you can read about here: Johns Hopkins. It is important to note that the diet is not a substitute for medication or other treatments. Rather, it is an aid. If you have had success with this type of diet controlling your seizures or have comments, please let us know.

      9. Can I drive if I have epilepsy?
      Our main concern as caregivers is your safety. If we know that you are having seizures, we are concerned about you having an accident if the seizures are not under control. Our concern is two-fold: we are concerned about you and we are concerned about fellow drivers. From a legal perspective, if you have seizures that alter your awareness, consciousness, or muscle control, you may not have the legal right to drive. Each state has its own restrictions, which the Epilepsy Foundation has listed on its Web site at: Epilepsy Foundation. You will see that most common requirements are that you remain seizure free for a specific period of time and submit a physician's evaluation of your ability to drive safely. Another common requirement is the periodic submission of medical reports, either for a specified period of time or for as long as you remain licensed. In Florida, for example, a person with epilepsy may be licensed to drive upon their doctor's recommendation after they have been seizure free for six months, so long as they are under regular medical supervision and submit a current neurological evaluation. Please check your state's law and work with your physician to determine the best route to take for the safety of you and your fellow drivers.

    For additional information, check our blog, or post your comment at: ASK THE EXPERTS - BLOG

  • HEADACHES


  • Chronic headaches interfere with a person's career, relationships and overall quality of life. Fortunately, there are diagnostic tools and effective treatments available.

    When a patient visits Florida Neuroscience Center with troublesome headache symptoms, we first seek to understand the origin and reason that the headaches are occurring. We thoroughly evaluate the patient's condition by taking a medical history, physical examination and other relevant tests. These tests may include a CT scan or an MRI.

    Generally, we find that there are two main types of headaches: primary and secondary.

    • Primary headaches are the most common and are usually categorized as tension, migraine or cluster headaches. These types of headaches can be caused by stress, caffeine, lack of sleep or lack of exercise, for example.


    • Secondary headaches are caused by underlying diseases or conditions such as tumors, inflammation, meningitis or fluid on the brain.


    Depending on the patient and what type of headache he or she has, we work together to outline a manageable approach, which may include medication, stress management, dietary changes, weight loss, and/or improved sleep strategies. By designing individualized treatment plans to help a patient implement healthy lifestyle habits, with effective alternative treatments and appropriate use of medications, we help our patients move toward living a full and satisfying life.

    For additional information, check our blog, or post your comment at: ASK THE EXPERTS - BLOG

  • BACK PAIN


  • Back pain is one of the most common medical problems, which can be debilitating. Symptoms range from achiness to shooting pain, spasms, stinging or twinges. According to the American Pain Foundation, back pain is the leading cause of disability in Americans under 45 years old, and more than 26 million Americans between the ages of 20 and 64 experience frequent back and neck pain.

    There are many causes for back pain, but it is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Typically, back pain presents in several forms, from lower back pain, middle back pain or upper back and neck pain to low back pain with sciatica. Causes include injury from sports or car accidents, nerve and muscular problems, spinal or disc degeneration and arthritis.

    Although the causes of back pain are usually physical, it is important to know that emotional stress can also play a role in the severity of the pain and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.

    At Florida Neuroscience Center, we focus on diagnosing the root cause of a patient's back pain and then work together to create a comprehensive treatment plan that will improve the overall quality of life.

    After taking a patient's medical history, we might order an MRI or closely examine previous MRIs to detect conditions or issues that may have been overlooked. We want to ensure that the pain is not due to an underlying disease or tumor. Most back pain can be treated without surgery. A treatment plan might include a combination of pain management medications, physical therapy and psychiatry, taking the whole person and their overall well-being into account.

    For additional information, check our blog, or post your comment at: ASK THE EXPERTS - BLOG

  • CHALLENGE YOUR MEMORY


  • BRAIN FITNESS: FACT OR FICTION?

    By now many of you are probably asking what is all the hype about brain fitness? Well, as we have come to learn and understand the benefits of physical exercise to keep our bones strong and our hearts healthy, we are also learning about the benefits of implementing a mental exercise plan to keep our memory sharp and stimulated.

    Studies have shown that those people who exercise their brain regularly will enhance problem-solving abilities, have the ability to think faster, and improve their reasoning and logical skills. Conversely, if the brain is not regularly challenged, it can grow weak and its functions will decline. Most importantly, by regularly exercising your brain, you could be protecting yourself from the development of brain-related illnesses, such as dementia and Alzheimer’s disease.

    Challenging your memory, through the introduction of new experiences, will “wake-up” the unused areas of the brain enabling it to function better. No need to invest money on computer software, try simple at-home activities such as, tasting new foods, learning to play an instrument, or driving a different route to work.

    We will regularly post new activities to help you challenge your memory, so stay connected! Also, stay tuned for exciting new information about the upcoming Florida Neuroscience Memory Center, a hands-on approach to keeping your memory alive and healthy. We look forward to hearing from you.

    For additional information, check our blog, or post your comment at: ASK THE EXPERTS - BLOG

  • NEURODIAGNOSTICS


    • Electroencephalograms (EEGs)
    • Electromyograms (EMGs)
    • Evoked Potentials (EPs)
    • Ambulatory EEG monitoring
    • and
    • In-Hospital Epilepsy Monitoring at Holy Cross Hospital

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