New Strategies for Treating Epilepsy

We would like to provide  insight into treatment options for this complex neurological condition that affects 1 in every 26 individuals.

Characterized by seizures, epilepsy has many different causes and types. Because of this, there are a variety of surgical and non-surgical epilepsy treatment options.

Non-Surgical Epilepsy Treatment Options

In more than two-thirds of epilepsy patients, antiepileptic medication can effectively control seizures. To determine the most optimal medication, an accurate diagnosis of the type of epilepsy is required.  The type of medication selected also depends on the potential side effects, other illnesses the patient might have, and the most acceptable delivery method for the medication.

Sometimes lifestyle modifications can reduce the chances of experiencing a seizure. In some patients, certain behaviors or factors can trigger seizures and in such cases, these activities should be reduced or avoided. These can include:

Stress or mental strain
Alcohol or drugs
Changes in sleep schedule
Over stimulation from flashing lights or video games in those individuals with specific light-sensitive reflex epilepsies.
A “ketogenic” diet can also help to control difficult-to-control epilepsy in some children. This diet, which is high in fat and protein and low in carbohydrates, can reduce the frequency of seizures by elevating ketone bodies in the blood.

Treating Epilepsy with Surgery

In some patients, medication and lifestyle modifications are not sufficient for controlling seizures. In these cases, surgery may be an option.

Surgery may be directed to further identify the region responsible for seizure onset (the focus), may be to remove the focus, may involve operations to disconnect the seizure producing focus from the rest of the brain, or may involve the use of neurostimulation to suppress seizures.

Many times seizures cannot be localized adequately by scalp EEG. A craniotomy for the placement of subdural strips and grids may improve seizure localization. Surgical removal of a part of the brain that is giving rise to seizures can sometimes lead to a cure of epilepsy.

One example is what is called a temporal lobectomy.   When seizures are coming from more than one area of the brain and medications are not working, a procedure called vagus nerve stimulation may be recommended. This is an outpatient procedure where the surgeon places an electrode on the vagus nerve in the neck and connects it to a pacemaker.

Among the newest treatments is the NeuroPace RNS® System which is a revolutionary, implanted stimulator. The pacemaker for this device continuously monitors the patient’s EEG. When it detects an abnormal EEG pattern it can deliver small bursts of electrical stimulation to prevent development of a seizure. With the addition of the NeuroPace RNS® System patients who previously felt there were no further options to control their seizures can now look forward to a better quality of life. NSPC’s Dr. Brian Snyder is the first neurosurgeon on Long Island to implant this innovative stimulator which was recently approved by the Food & Drug Administration.