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.
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.
- Vagus nerve stimulator – 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.
- Medical treatment – Epilepsy is often managed with an anticonvulsant medication. Periodic blood testing monitors both the drug’s impact and safety. If you are prescribed an anticonvulsant drug, be sure to tell your epileptologist about all of the other medications you are taking to avoid dangerous drug interactions.
Not all epilepsy patients respond well to treatment that consists of only medication. If seizures continue despite one or more medications, epilepsy surgery may be necessary. For those patients, we offer a variety of pre- and post-surgical evaluations, including:
- Video electroencephalogram (EEG) monitoring – During a pre-surgical evaluation, the patient is admitted to the hospital for 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. The patient’s team of physicians review the test data and discuss 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.
- Magnetic resonance imaging (MRI) – This study detects structural defects in the brain to identify where the seizures may arise.
- Magnetic resonance spectroscopy – Determines the presence of biochemical markers which may indicate where seizures arise in the brain.
- Positron emission tomography (PET) scan – Visualizes the metabolic activity in the brain using a radioisotope administered through an IV. When viewed through the PET scan, areas of the brain that are less metabolically active as a result of seizure activity will contain lower concentrations of the radioisotope.
- Single photon emission computed tomography (SPECT) scan – This test helps determine where a seizure originates in the brain by measuring blood flow in different areas.
- 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.
- 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 language 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.
- 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. Patients who undergo pre-surgical evaluations may also find psychological interventions helpful.