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Hope for epilepsy patients

Drug, surgery and implant options for people with epilepsy

An estimated 3.4 million Americans and 50 million people worldwide live with epilepsy, making it one of the most common neurological diseases across the globe. Dr. Shankar Perumal, a neurologist with Novant Health Neurology Specialists, explained that many people with the condition still lead a normal life and described treatment options, which can include medication, surgery and implanted devices. Some answers to common questions about the disease:  

What is epilepsy? Epilepsy is a neurological disorder that causes recurrent seizures. A seizure occurs when there is a sudden surge of electrical activity in the brain, disrupting brain function. The disruption can cause confusion, convulsions, loss of consciousness or other neurological symptoms.  

What causes epilepsy? There are multiple causes, the most common being stroke, traumatic brain injury, head injuries, infections or a brain tumor. Some people are born with brain malformations that can cause hyperactive electricity in the brain, resulting in epilepsy. 

What does a seizure look like? Some seizures can look like staring spells while others can cause a person to fall, shake, and lose awareness of what’s going on around them.  

What are the different types of seizures? Seizures are classified into two groups: generalized seizures and focal (partial) seizures. Generalized seizures affect both sides of the brain, while focal seizures are located in just one area of the brain. Tonic-clonic seizures, a type of generalized seizure, are associated with uncontrollable shaking, falling, crying out and loss of consciousness. These are the types of seizures that most people think of when they hear the word “seizure.”  

What is a common misconception about epilepsy? That people cannot participate in normal activities and have to change everything about their life. Many people living with epilepsy lead completely normal lives. 

What should I do if I see someone having a seizure? In the case of a generalized seizure (shaking and convulsing), roll the person on their side and make sure they are out of harm’s way. Do not put anything in their mouth, but put something soft under their head. If the person does not have a known seizure disorder or if they have injured themselves in any way, call 911.  

How is epilepsy most commonly treated? Medication is typically the first line for treatment. It’s effective in the majority of cases, and we now have over 20 medications available.  

What other options do epilepsy patients have? If a patient has tried 2-3 medications that were not effective, they are considered to have refractory epilepsy. At this point, we would evaluate them to see if they are a good candidate for surgery. If we are able to determine the focal point of the seizures (where the electrical impulses are firing from), we can potentially remove the source of the seizures.  

There are also implantable devices to help control seizures. The vagal nerve stimulator is one such device. This is a pacemaker-like device that is placed in the chest and sends intermittent signals to the brain to help reduce seizures.  

Our newest option for treatment of epilepsy is responsive stimulation, also called NeuroPace. This involves placing electrodes at the site of seizures which is attached to a stimulator device that is placed in the skull. This device detects seizures as they are beginning and stimulates the electrodes to prevent the seizure from progressing.

Published: 2/6/2018