Epilepsy Treatment Options: Hospital Care And Beyond

Doctors use a variety of methods to treat epilepsy in hospitals. The first step is usually to prescribe anti-seizure medication, which limits the spread of seizures in the brain and works for about 2 in 3 people with epilepsy. If medication is unsuccessful, doctors may suggest minimally invasive procedures, dietary changes, or advanced imaging tests and treatments. In some cases, surgery may be recommended, especially if seizures originate from a single area of the brain. Neurologists and epileptologists (neurologists who specialize in epilepsy) can provide general care and prescribe medication, and epilepsy centers offer cutting-edge technologies and advanced tests for those with hard-to-control seizures.

Anti-seizure medication

Doctors will often prescribe anti-seizure medication (ASM) as the first course of treatment for epilepsy. ASM limits the spread of seizures in the brain and works for about two in three people with epilepsy. It may take time to find the right medication, and sometimes a combination of medicines is required. It is very important to take ASM as prescribed, and to not skip or stop taking it without talking to a healthcare provider, as this could cause withdrawal symptoms, including life-threatening seizures.

If a person continues to experience seizures while taking ASM, they should inform their doctor immediately. The doctor may then change the amount or type of medicine. ASM can cause side effects such as tiredness or trouble thinking, and these should be reported to the doctor so that the medication can be adjusted if necessary.

If medication is not successful in treating epilepsy, doctors may suggest minimally invasive procedures, dietary changes, or advanced imaging tests and treatments. A ketogenic diet—a strict, high-fat, low-carbohydrate diet—is typically used for children whose seizures don't stop. Dietary changes are often combined with the guidance of a registered dietician.

If a patient has tried two or more anti-seizure drugs without success, it may be worth visiting a comprehensive epilepsy center, where the top epilepsy doctors work with cutting-edge technology to perform advanced tests.

Surgical procedures

Vagus Nerve Stimulation (VNS)

VNS is a procedure where a small pulse generator (stimulator) is implanted inside the body and connected to the left vagus nerve in the neck. The stimulator emits electrical pulses that travel through the vagus nerve to the brain, helping to regulate abnormal electrical activity and reduce the frequency and intensity of seizures.

Responsive Neurostimulation (RNS)

RNS is a more advanced form of neurostimulation that does not require the removal of brain tissue. It involves implanting a small device under the scalp that detects abnormal electrical activity in the brain and responds by delivering mild electrical pulses to interrupt the seizure activity.

Neuropsychological Tests and Brain Imaging

Neuropsychological tests, such as evaluating memory, thought processes, and speech, can help determine the origin of seizures. Advanced brain imaging techniques like positron emission tomography (PET) and single-photon emission computerized tomography (SPECT) can also help identify the location of seizures by visualizing metabolic activity and blood flow in the brain, respectively.

Focal Surgery

When seizures originate from a single area of the brain (focal seizures), surgery to remove the affected area may be considered. This approach can stop future seizures or make them more manageable with medication.

Anti-Seizure Medication

While not a surgical procedure, anti-seizure medication is often the first line of treatment for epilepsy. These medications work to limit the spread of seizures in the brain, and it may take time to find the right combination and dosage that effectively controls seizures.

Imaging tests

Another imaging test is the computerized tomography scan (CT), which uses X-rays to create cross-section images of the brain. CT scans help identify abnormalities in the brain, such as bleeds, tumors, or cysts. Magnetic resonance imaging (MRI) is also used to produce detailed pictures of the brain using magnets and radio waves.

Positron emission tomography (PET) is an imaging test that can detect brain abnormalities by injecting a small amount of low-dose radioactive medicine into a vein, allowing doctors to visualize the metabolic activity of the brain. Areas of low metabolism could indicate the location of seizures. Single-photon emission computerized tomography (SPECT) is a similar test that uses small amounts of radioactive medicine injected into a vein to create a detailed 3-D image of the blood flow activity in the brain during a seizure. The increased blood flow areas during a seizure can pinpoint where the seizures originate.

These advanced brain imaging tests and treatments are available to patients who may not be eligible for surgery or for whom medication has not been successful.

Dietary changes

The ketogenic diet was first introduced in 1921 to treat epilepsy and avoid the malnutrition that occurs with prolonged fasting. The diet aims to induce ketosis, mimicking a fasting situation where the body uses fatty acids as its primary source of energy. The diet is typically prescribed and monitored by a healthcare provider, such as a neurologist or epileptologist, and may be recommended when medication or surgery are not an option.

While the ketogenic diet is the most well-established dietary therapy for epilepsy, other dietary approaches include the Atkins diet (high fat, high protein, low carbohydrate), caloric restriction, and a gluten-free diet. These diets may also exert beneficial effects on neuroprotection and, therefore, on refractory epilepsy. It is important to note that dietary changes should not replace medications, and patients should continue their prescribed treatment plans as directed by their healthcare providers.

In addition to specific dietary regimens, there are certain foods that people with epilepsy may want to avoid. In general, specific foods are not known to cause seizures, except in rare cases of reflex epilepsy. However, some people with reflex epilepsy may find that certain foods or even smells can trigger seizures. Foods that are high in sugar, have a high glycemic index, or cause energy peaks and slumps can be problematic. Extreme high or low blood sugar can increase the risk of seizures. Foods and drinks containing stimulants, such as caffeine and chocolate, may also trigger seizures by interfering with epilepsy medication or other nervous system pathways. Alcohol and diets high in salt should also be avoided, as they can increase the risk of seizures.

Overall, while dietary changes can be an effective adjunct to other epilepsy treatments, it is important to consult with a healthcare provider before making any significant dietary modifications. Proper nutrition and a balanced, nutritious diet are crucial for overall health and epilepsy management.

Neurologists and epileptologists

Neurologists are doctors who specialise in the brain and nervous system. They can provide general care for epilepsy patients and prescribe medication to treat seizures. Neurologists can refer patients to epileptologists, who are neurologists specialising in epilepsy, if seizures persist.

• Computerized tomography (CT) scans, which use X-rays to view cross-section images of the brain and can help discover abnormalities like brain bleeds, tumours, or cysts.
• Magnetic resonance imaging (MRI), which uses magnets and radio waves to create detailed pictures of the brain.
• Positron emission tomography (PET), which involves injecting a small amount of low-dose radioactive medicine into a vein to visualise the metabolic activity of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT), which uses small amounts of injected radioactive medicine to create a 3-D image of the blood flow activity in the brain during a seizure.

Neuropsychological tests are also used to evaluate mental functions such as thought, memory, and speech, which can help determine the origin of the seizures.

• Vagus nerve stimulation (VNS), which involves inserting a pulse generator that releases electrical pulses through the vagus nerve to help regulate abnormal electrical brain activity.
• Responsive neurostimulation (RNS), which does not require the removal of brain tissue.
• A ketogenic diet, which is a strict, high-fat, low-carbohydrate diet typically used for children with seizures.

Frequently asked questions