Epilepsy Education & Treatment
Epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a person’s consciousness, movement, or actions may be altered for a short time. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder. Some people can experience a seizure and not have epilepsy. For example, many young children have convulsions from fevers. These febrile convulsions are one type of seizure. Other types of seizures not classified as epilepsy include those caused by an imbalance of body fluids or chemicals or by alcohol or drug withdrawal. A single seizure does not mean that the person has epilepsy.
Almost any type of behavior that happens repetitively may represent a seizure.
Generalized seizures: All areas of the brain (the cortex) are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures.
- To the observer, the person experiencing such a seizure may cry out or make some sound, stiffen for some seconds, then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping.
- Eyes are generally open during an epileptic seizure.
- The person may not appear to be breathing. The person is often breathing deeply after a seizure.
- The return to consciousness is gradual and should occur within a few moments.
- Loss of urine is common.
- Often people will be confused briefly after a generalized seizure.
Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary.
- If the part of the brain controlling movement of the hand is involved, for example, then perhaps only the hand may show rhythmic movements or jerking.
- If other areas of the brain are involved, symptoms might include strange sensations or small repetitive movements such as picking at clothes or lip smacking.
- Sometimes the person with a partial seizure appears dazed or confused. This may represent a partial complex seizure. The term complex is used by neurologists to describe a person who is between being fully alert and unconscious.
Absence or petit mal seizures: These are most common in childhood.
- Impairment of consciousness is present with the person often staring blankly.
- Repetitive blinking or other small movements may be present.
- Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day.
- Other seizure types exist, particularly in very small children
Anything that disturbs the normal pattern of activity in the brain can trigger epilepsy.
The cause can be illness, brain damage, or abnormal development of the brain. No cause can be determined for most of the cases of epilepsy.
Because epilepsy has so many causes and can be linked to a number of other conditions, it is sometimes very difficult to determine the cause of a particular case. They include:
- Brain chemistry
- Hereditary causes
- Other disorders
- Head injury
- Prenatal injuries
- Environmental causes
When the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of epilepsy treatment. If the epileptic seizure was caused by an underlying correctable brain condition, surgery may stop seizures. If epilepsy — that is, a continuing tendency to have seizures — is diagnosed, the doctor will usually prescribe regular use of seizure-preventing drugs. If drugs are not successful, other treatment methods may be tried, including surgery, a special diet or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives. In some cases, more than one drug will be necessary to stop the seizures.
|Carbamazepine||Partial seizures, generalized seizures|
|Lamotrigine||Generalized and partial seizures|
|Phenobarbital||Generalized and partial seizures|
|Phenytoin||Generalized and partial seizures|
|Topiramate||Generalized and partial seizures|
|Valproate||Generalized and partial seizures|
|Pregabalin Vimpat||Partial seizures|
VNS (Vagus Nerve Stimulation)
Vagus nerve stimulation treatment therapy is another form of treatment that may be tried when medications fail to stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other treatments. The treatment therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.
The energy is delivered by a flat, round battery, about the size of a silver dollar, which is surgically implanted in the chest wall. Thin wires (electrodes) are threaded under the skin and wound around the vagus nerve in the neck. The battery is programmed by the health team to send a few seconds of electrical energy to the vagus nerve every few minutes. If the person with the system feels a seizure coming on, he or she can activate the discharge by passing a small magnet over the battery. In some people, this has the effect of stopping the seizure. It is also possible to turn the device off by holding the magnet over it.
Implanting the VNS battery in a patient and connecting it to the vagus nerve takes about an hour. It is usually done under general anesthesia, though local anesthesia is sometimes used. The operation can be done on an in-patient or out-patient basis.
The neurologist makes two small incisions — one in the neck to gain access to the vagus nerve, and one below the collarbone in the chest wall or armpit.
The neurologist places the VNS pulse generator into a surgically-made “pocket” under the skin of the patient’s chest and threads a plastic tube containing the electrodes from the neck to the generator in the chest. He or she then gently wraps the flexible ends of silicone-coated electrodes around the vagus nerve.
Programming the Device
Some neurologists turn on the VNS device immediately after surgery. Others prefer to start the stimulation during the check up visit afterward. neurologists program the device to deliver pulses of electrical stimulation automatically, 24 hours a day.
A typical “dose” is about 30 seconds on and five minutes off, but settings may vary. The device continues the cycle until the neurologist re-programs it or until the battery runs out — usually in about six years.
At that time, another surgical procedure (which only involves the chest) can be done to replace the battery, usually with a local anesthetic. Side effects of VNS treatment therapy are mostly hoarseness and, sometimes, discomfort in the throat. There may be a change in voice quality during the actual stimulation. Although complete seizure control is seldom achieved, the majority of people who use VNS therapy experience fewer seizures. In some, its effectiveness increases with time, and patients report an improved quality of life. As with surgery and the ketogenic diet, it will almost always be necessary to continue anti-epileptic medication although the patient may be able to take less medication than in the past.
Unfortunately there is no cure for epilepsy; however many patient’s seizures can remain well controlled and can become seizure free for a long time when given the proper, best treatment for that person. Every case; however, is very different and some people will never become seizure free.