Diagnosing and Treating Epilepsy
Epilepsy may be diagnosed through a detailed medical history and electroencephalogram (EEG) video monitoring to record brain wave patterns during and between seizures. Imaging scans (such as an MRI) of the brain and blood tests are performed to help rule out other potential causes of seizures, such as a brain tumor or other disease.
For a majority of patients, antiepilepsy drugs are helpful, with the goal of controlling the seizures while minimizing medication side effects. Properly diagnosed and treated, most people with epilepsy do very well. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication.
Surgery as an Option
Approximately one third of people with epilepsy who have tried anti-seizure medications may still suffer from frequent and disabling seizures. For some of these patients, surgery may be an option. In particular, epilepsy surgery may benefit patients whose seizures are associated with structural brain abnormalities, such as brain tumors, malformations of blood vessels and damage related to strokes.
The main goal of epilepsy surgery is to determine where the seizures are coming from and to resect (remove) that part of the brain to make the person seizure free.
When Surgery Isn't an Option, Stimulation Treatment May Be
For those who cannot have resective surgery, either because they have more than one area from where seizures are coming from, or because the region that seizures are coming from is providing an important function, (such as language or memory), stimulation treatment may be an option.
These include vagal nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS). All three procedures are offered at our Stony Brook Level 4 Comprehensive Epilepsy Center. Though typically not curative, these stimulation treatments, which use an electrical device known as a pacer, can significantly reduce seizure frequency over time. (At times it may take a number of years to reach a significant reduction.)
Vagal nerve stimulation (VNS) uses a pacer that is implanted under the left clavicle (collarbone) with electrodes that are wrapped around the left vagus nerve and transmit pulses. The exact mechanism of this device is not fully understood. The stimulation is thought to affect the nerve fibers of the vagus nerve that project to the brain stem and from the brain stem, electrical signals eventually reach the cortical areas of the brain.
Responsive neurostimulation (RNS) uses a pacer that is implanted in the patient's skull. It has two active leads in the brain that are typically implemented near the suspected seizure focus. When seizure activity is detected, the electrodes can transmit a signal that can stop the seizure.
Deep brain stimulation (DBS) is the most recently FDA approved stimulation device for use in the treatment of epilepsy in the United States. (DBS has been FDA approved for use in the treatment of tremors for years.) With DBS, a pacer is typically implanted on the chest wall, and the leads (insulated wires) are placed in both sides of the thalamus (part of the brain responsible for relaying motor and sensory signals to the cerebral cortex) in areas called the anterior nucleus. This is a region through which a seizure often spreads and by stimulating this area, we can reduce the frequency of the seizures.
Diet as Treatment
Diet can also be a treatment for some, specifically the ketogenic diet or a modified Atkins diet. The diets are prescribed by a physician and carefully monitored by a dietitian.
