Epilepsy and Its Various Treatment Options

When you think about epilepsy, you most likely picture someone having a dramatic seizure, where they collapse to the ground with frightening jerking movements and loss of bodily functions. These episodes, known medically as “general tonic-clonic”seizures, or traditionally referred to as “grand mal” seizures, are just one of several different types of seizures that happen when the brain’s neurons misfire and release neurotransmitters, which occurs with epilepsy.

What is Epilepsy?

According to the U.S. Centers for Disease Control and Prevention (CDC), epilepsy is a disorder of the brain that causes a person to experience at least two seizures more than 24 hours apart. With epilepsy, there’s no apparent cause, such as medication, illicit drug activity or a metabolic imbalance, for the seizure.

Andrew Lerman, M.D., a neurologist with Miami Neuroscience Institute, says the most definitive way to diagnose epilepsy is with a video electroencephalogram, or EEG. An EEG measures the brain’s electrical activity and the video component captures the body’s reaction to the abnormal brain activity.

Other tests may also be performed to find or rule out other causes for the seizures. These tests include:

• A neurological exam
• A blood test to diagnose hormonal imbalances
• Imaging tests to find lesions on the brain that may indicate a stroke or brain tumor
• A spinal tap to rule out infection

“These tests help put everything together to provide an accurate diagnosis,” Dr. Lerman said.

Epilepsy Treatments

Once epilepsy has been diagnosed, treatment is necessary to improve quality of life and prevent disability resulting from repeated seizures.

Medication
Dr. Lerman says that the first line of treatment for epilepsy is medication. Research has netted significant improvements in medications used to target certain areas and functions of the brain and control the different types of seizures that occur with epilepsy.

“We now have about 20 to 25 medications we can use to help manage epilepsy and other seizure disorders,” he said. “We may need to combine medications through trial and error to find the formula that works best, but most patients have their epilepsy controlled with medication.”

Surgical Options
For patients whose seizures fail to respond to medications, as in “medically refractory epilepsy,” surgical options exist. In addition to those patients, Dr. Lerman says surgery often helps patients whose epilepsy affects one area of the brain. Common procedures include:

• Laser Interstitial Thermal Therapy (LITT) – a minimally invasive procedure in which the area of the brain where seizures originate is exposed to a laser, creating a type of scar that stops abnormal signals from occurring.
• Implantation of a Responsive Neurostimulation (RNS) device – a pacemaker-like device implanted into the skull that senses abnormal brain activity and delivers electrical stimulation to the brain to stop a seizure from happening.
• Lobectomy – surgeons remove a portion of the temporal lobe of the brain where seizures originate in temporal lobe epilepsy.
• Corpus callosotomy – surgeons disconnect the right and left sides of the brain to prevent seizures that occur on one side from moving to the other side.
• Hemispherectomy – for severe cases of epilepsy, surgeons remove a portion of or an entire half of the brain involved with seizures.

Dr. Lerman says that these technological advances, especially in the areas of minimally invasive procedures, such as RNS and LITT, are greatly improving the management of epilepsy and the quality of life for patients who undergo them.

Complementary Treatments
In addition to medical and surgical treatments for epilepsy, some patients have turned to alternative, complementary therapies that have shown promising results.

Patients with refractory epilepsy, who have adopted a strict ketogenic, or “keto,” diet, for example, have seen effective management of their seizures. Dr. Lerman says that’s because the burning of fats, instead of carbohydrates, for the body’s fuel leads to changes in the metabolism of the brain. He says the keto diet can be effective if carefully followed.

Additionally, the U.S. Food and Drug Administration in June approved a drug, Epidiolex – a cannabidiol oral solution – for the treatment of two severe and rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Cannabidiol, or CBD, is derived from the plant used to make marijuana, but doesn’t contain the high-producing chemical tetrahydrocannabinol, or THC, according to the FDA. Dr. Lerman says the CBD acts like other chemicals that are naturally in our brains and help suppress seizures.

Living With Epilepsy

Dr. Lerman says it’s important to treat epilepsy to control seizures. “Our greatest fear is the risk of disability from seizures,” he said. “Seizures can even lead to death.”

He warns that the stigma associated with epilepsy must be addressed through education of patients, their families and the public. “Epilepsy is a medical condition that is manageable and treatable,” he said. “By educating others about the disease and its treatment options, as well as providing social resources to help patients and their caregivers cope with the management of seizures, we can minimize the stigma and improve patients’ quality of life.”

Dr. Lerman points to the Epilepsy Program at Miami Neuroscience Institute as one of only a few programs in the U.S. that combines advanced treatment approaches with education and social management of epilepsy. In fact, it has been designated a Level 4 Epilepsy Center by the National Association of Epilepsy Centers. At Baptist, patients have access to a multidisciplinary and comprehensive approach to epilepsy care, including optimization of medications, complete pre-surgical evaluations and the latest surgical procedures for epilepsy. Moreover, Baptist provides psychosocial support to patients and their caregivers.

“Family involvement is crucial to epilepsy care,” Dr. Lerman said. “Baptist Health’s program recognizes that and offers caregivers the support they need. We’re living in exciting times to help patients with epilepsy have normal lives.”

Tags: Andrew Lerman M.D., Epilepsy Program, Miami Neuroscience Institute