Brain and Spine

Advances in Epilepsy Treatment

Epilepsy treatment

Epilepsy impacts people of all ages. It is a chronic neurological disorder marked by recurrent, unprovoked seizures. In the United States, more than 3 million people are living with epilepsy today.

What are epileptic seizures?

Epileptic seizures stem from disturbances in the brain’s electrical activity.  “There are various causes of epileptic seizures such as genetics, abnormal development of brain tissue, and other structural abnormalities such as traumatic brain injury, tumors, stroke, or infection such as meningitis or encephalitis,” says Elsie Achieng, M.D., a neurologist and sleep medicine physician with Riverside Neurology Specialists. “The reason for epilepsy is also sometimes unknown. Fortunately, there continues to be new advances in epilepsy treatment.”

How a seizure looks when a person is having one can vary, and physicians put them into different categories. While some people think of seizures as only being physical movements, seizures can also occur without movements. This depends on where the abnormal electrical activity occurs in the brain, such as areas that control sensation, emotions, thinking and other functions.  

When patients are diagnosed with epilepsy, their physicians work hard to understand their seizures and find out the type.  The seizure type is based on how the seizure starts, the person’s  awareness during the seizure, and if there are movements. 

Understanding the type of seizure is the first step to planning treatment to help prevent or lessen the impact of the seizures.

How is epilepsy managed?

A good treatment plan for your epilepsy includes five things. These things give patients the power to take control of how epilepsy impacts their life.

1. Track and know your triggers

Keeping a seizure diary can help you and your physician see any patterns in your seizures, and help find out what may be triggering them.  Many people find things such as flashing lights, alcohol or drug use, menstrual cycles, caffeine, not enough sleep, certain foods or missing medication doses can trigger their seizures.

2. Focus on wellness

Working to keep your body and mind healthy helps to manage seizures. Getting enough sleep, eating right, getting regular exercise, and managing stress is important. Finding routines that work for you, whether that is yoga, naps, meditation or running is an important step in managing your epilepsy.

3. Educate your family, friends, teachers, or co-workers on how to help and what to do if you have a seizure 

The Epilepsy Foundation recommends creating a Seizure Action Plan to let others know what to do. It can include information on providing first aid, when to call your physician and when to call 911. It can also include contact information so your emergency contacts can be notified as well as any pertinent medical information that may need to be shared with EMS if 911 is called. 

4. Create and stick to a medication management plan

Your physician will work to find a medication – or combination of medications – to manage your epilepsy.  Anti-epileptic drugs are almost always the first line of treatment.  And, 7 in 10 people are able to control their epilepsy with these medicines.  It is very important to take your medications on time every day, and you should never stop or change your medications without talking to your physician. Dr. Achieng notes, “Many people find using watch alarms or phone apps to remind them to take their medications helps them stick to their medication plan.”

5. Talk to your doctor and speak up if your medication plan isn’t working

Talking to your doctor and nurses about your seizures, and whether or not you feel the medications are working is also important.  If the timing of a medication routine is too hard for you to manage, or if you are having side effects, your doctor will want to know so you both can talk about a new plan. Epilepsy research is ongoing.  There are new medications and other types of treatments that can be considered as well as some surgeries. Staying in contact and talking often with your physician helps you and your care team manage your seizures. 

Neurosurgical treatments for epilepsy

For some patients, their seizures cannot be controlled by medication alone. These patients often look at having surgery to manage their epilepsy. The type of surgery depends on the types of seizures, and the location of the seizures in the brain. Some of the major  kinds of surgery include:

Craniotomy and Resection

Certain seizures begin in a single location in the brain and this part of the brain can be safely removed.  In a craniotomy, the skull is opened and the specific area of the brain causing the problem is resected, or removed. In many cases, this neurosurgery lowers the number of seizures and may even stop them. The specific type of craniotomy will depend on which portion of the brain is impacted.  

Lesionectomy

When the seizures are caused by structural abnormalities like tumors or vascular malformations, a lesionectomy can remove the lesion and some of the tissue around it to stop the seizures.

Stereotactic Radiosurgery

Sometimes called “knifeless brain surgery,” stereotactic radiosurgery uses precisely focused beams of radiation to treat the source of the seizures. Each single beam of radiation is small but where they come together is at the precise point where you need treatment. To learn more about radiosurgery, please visit the Chesapeake Regional, Riverside and University of Virginia and Radiosurgery Center website.

Neurostimulation

Some of the most recent research advances on epilepsy treatment are in the area of neurostimulation  Vagus Nerve Stimulation, Responsive Neuro Stimulation and Deep Brain Stimulation have all been approved to treat certain forms of epilepsy.  The concept behind each is that electrical stimulation is applied directly to the nerve to stop the signals which would trigger a seizure. Forms of neurostimulation are also used to treat other neurological conditions, including Parkinson’s disease, essential tremors dystonia, obsessive-compulsive disorder, and severe depression. 

If you have experienced one or more seizures, be sure to talk to your physician. To see a Riverside primary care provider call 757-534-5352 to make an appointment. To see a Riverside neurologist, call the location nearest you.

  • Riverside Neurology Specialists – Newport News: 757-534-5100
  • Riverside Neurology Specialists – Hampton: 757-637-7500
  • Riverside Neurology Specialists – Williamsburg: 757-221-0110
  • Riverside Neurology Specialists – Gloucester: 804-695-8550
  • Riverside Eastern Shore Physicians and Surgeons Neurology – Onancock: 757-302-2700

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