Advances in epilepsy treatment
Published:Wednesday | January 24, 2024 | 12:05 AM
EPILEPSY MAY be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure, and whose tests do not indicate a high likelihood of seizure recurrence, may not need medications.
The medications treat the symptoms of epilepsy (the seizures), rather than curing the underlying condition. They are highly effective and completely control seizures in the majority of patients. The drugs prevent seizures from starting by reducing the tendency of brain cells to send excessive and confused electrical signals.
With many different antiepileptic drugs currently available, choosing the right medication for an individual patient has become complicated. The choice of medication depends on a variety of factors, some of which include the type of seizure and type of epilepsy, the likely side effects of the medication, other medical conditions the patient may have, potential interactions with the patient’s other medications, age, gender, and cost of the medication.
Before any drug is prescribed, patients should discuss potential benefits, side effects and risks with their doctors.
According to Dr Luis Tornes, director of epilepsy at Miami Neuroscience Institute, today’s treatments involve highly personalised strategies that target the specific cause of seizures in an effort to lessen or eliminate them. Technological advances include not only tiny electrodes and lasers, but MRI machines that provide high-resolution images during surgery, and implanted devices that can stop a seizure in its tracks.
“Advances in medication and other treatment options have made it possible for many people with epilepsy to control their seizures effectively. This can lead to a marked improvement in quality of life, allowing individuals to participate in most of the activities that those without epilepsy can,” Dr Tornes said.
“Treating epilepsy effectively requires a team approach involving various specialties. Our institutes bring together experts in neurology, neurosurgery, neuroradiology and neuropsychology to provide well-rounded care for our patients. This multidisciplinary collaboration ensures that we can conduct all the necessary tests and studies under one roof, helping us identify the best possible treatment for each individual,” he added.
New antiepileptic medications, he said, provide us with the ability to tailor drug regimens according to an individual’s unique needs. “These certainly hold significance, but even more compelling are the developments in the field of surgical treatments, specifically neuromodulation. Minimally invasive therapies are expanding the landscape, offering promising alternatives,” Dr Tornes said.
There are advanced techniques that can modulate brain activity with electrical stimulation, interrupting, lessening or preventing seizures. These minimally invasive options include responsive neurostimulation, which sends electrical stimulation to the brain during a seizure to abort it in real-time; deep brain stimulation, which involves implanting a device to send electrical signals to the thalamus; and vagus nerve stimulation, where a device is implanted and then a lead is attached to the vagus nerve to control seizures. Each of these options offers its own benefits and risks, providing a range of choices for individualised treatment.
“There are several brain surgery options for patients who require them. These include callosotomy, which involves cutting connections in the brain to prevent seizures; hemispherectomy, the removal of one side of the brain; and lobectomy, the removal of a specific lobe of the brain. Another option is targeted resection or lesionectomy, where only the part of the brain causing seizures is removed. Laser ablation is a less invasive method that uses lasers to remove problematic areas,” Dr Tornes said.
Dr Tornes said his hope is that the public can become more understanding, educated and supportive about epilepsy.
“There should always be an opportunity to shed light on a condition that affects millions of people worldwide, impacting not just those who experience seizures, but also their families and communities. This is a condition that can affect anyone, regardless of age, race, or social standing. With greater awareness and understanding, we can make strides in improving the quality of life for those affected by epilepsy,” he said.
SOURCE: American Association of Neurological Surgeons