There are different types of epilepsy, as well as different causes and types of seizures. Patients with this condition require special attention to achieve a normal lifestyle, and while medications are effective in controlling most seizures, surgery and specialized diets also have benefits. Some treatment plans will also be tailored to address any co-existing conditions that may be present.
Experts at Atlantic Neuroscience Institute’s Epilepsy Center at Overlook Medical Center employ a wide range of treatments to help patients diagnosed with epilepsy or a seizure disorder:
- Ketogenic diet – This diet is high in fat and low in proteins and carbohydrates, and has an anticonvulsant effect in some epilepsy patients. To initiate the diet, the patient needs to be hospitalized for a few days.
- Medical treatment – Epilepsy is often managed with an anticonvulsant medication. Periodic blood testing monitors both the drug’s impact and safety. Patients who are prescribed an anticonvulsant drug, should tell their epileptologist about all of the other medications they are taking to avoid dangerous drug interactions.
- Responsive neurostimulation device (RNS) – A pulse of stimulation is sent directly to the brain to stop an individualized pattern of seizure activity. This treatment is used primarily for patients that have uncontrollable, partial onset seizures.
- Vagus nerve stimulator (VNS) – This two-piece, surgically implanted device may reduce the number and severity of seizures. After wrapping a wire around the vagus nerve in the neck, surgeons implant a small device resembling a pacemaker under the skin beneath the collar bone which sends an electrical impulse to the wire to stimulate the vagus nerve. The device can be programmed or activated “on demand" with a magnet.
For patients who are scheduled for epilepsy surgery or have had surgery already, our center offers pre- and post-surgical evaluations:
- Cortical mapping – During brain surgery, electrical stimulation is briefly applied to the cortical surface of the brain for the purpose of identifying areas critical to sensory, motor or language function, so that they are not inadvertently disrupted.
- Neuropsychological testing – This group of tests evaluates thinking, memory, language and other mental abilities, and is usually performed both before surgery and six to 12-months after surgery. The tests require several four-hour sessions with a neuropsychologist trained in epilepsy treatment. Pre- and post-surgery results are compared to assess the impact of surgery on cognitive function.
- Psychological support – Epilepsy, like most long-term or chronic disorders, can cause emotional distress, personal and social difficulties, and adjustment issues. Psychological treatment of depression and anxiety can help patients cope with stress and provide a supportive environment to aid the patient’s recovery and adjustment. Those who undergo pre-surgical evaluations may also find psychological interventions helpful.
- Video electroencephalogram (EEG) monitoring – During a pre-surgical evaluation, the patient is admitted to the hospital for a non-invasive study to determine the area of the brain in which the seizures originate. Anticonvulsant medications are discontinued for the duration of the monitoring so that several seizures can be recorded with simultaneous video image. Once the monitoring is complete, the patient resumes medication and can be discharged from the hospital. A team of physicians then reviews the test data and discusses the results with the patient, the referring physician and family members. If more than one area of the brain is generating the seizures, the patient cannot have surgery.
- Wada test – This test is performed in conjunction with an angiogram to determine which side of the patient’s brain is dominant for language and memory, thereby helping to prevent speech and memory loss after surgery. Amobarbital is injected through a catheter in the carotid artery to anesthetize the cerebral hemisphere while the physician tests memory and language skills. One hour later, the same procedure is performed on the brain’s other hemisphere.
Treatment for epilepsy will vary if any other conditions are present. It is common for many patients to experience anxiety, depression or mood disorders. In these cases, medications that have an adverse effect on behavior may not be prescribed and a referral to a behavioral medicine specialist may be provided.
Epileptic seizures are also sometimes caused by brain tumors. Usually, these patients are first prescribed medication, but if two different drugs are proven ineffective, then surgical removal of the tumor may be necessary.