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Contents
Procedure description: Epilepsy Treatment
Patient preparation: Epilepsy Treatment
Recovery: Epilepsy Treatment
Note: Epilepsy Treatment
Conditions: Epilepsy Treatment
Common Synonyms: Epilepsy Treatment
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| Procedure description: Epilepsy Treatment |
EPILEPSY TREATMENT OPTIONS
The most common treatment options for people with epilepsy are medications, surgery and vagus nerve stimulation.
The ketogenic diet is sometimes used for some children.
Type of epilepsy treatment depends on type and severity of epilepsy, and this varies from patient to patient.
Diagnosis of epilepsy can be recieved after two or more seizures , and it is also known as a seizure disorder.
It is believed that approximately 5 to 10 percent of the population will experience a seizure at some time in life.
EPILEPSY IN CHILDHOOD
Specific epilepsy syndromes which occur in childhood may stop as person approaches adulthood.
Other syndromes are associated with continued, but infrequent, seizures or are easily controlled with medication.
Unfortunately, some seizure disorders continue and may worsen with time.
Treatment Options
Generally, child epilepsy treatment options are the same as for adults.
Medications
First line of child epilepsy treatment are medications.
This type of epilepsy treatment should be started when additional seizures are expected to reappear, and, when there is a fear that these seizures could cause potential physical, educational or social harm.
This can be predicted by proper identification of seizure type(s) and epilepsy syndrome.
If seizures persist despite of available antiepileptic medications, several alternatives are available, depending on the seizure type(s) and the underlying cause:
KETOGENIC DIET
The ketogenic diet has been used primarily in childhood epilepsy.
The specific mechanism by which the ketogenic diet works is unknown.
The high-fat, low-protein, no-carbohydrate diet mimics some effects of starvation that seem to inhibit seizures.
Ketogenic diet is very rigid and carefully controlled, and must be supervised by a physician -- sometimes in a hospital setting.
Ketogenic diets have been used for epileptic children for many years with a success rate of approximately 50 percent.
Close collaboration with an experienced dietitian knowledgeable in the implementation of the ketogenic diet, and dedication of the patient and his or her family are essential for this treatment to work.
ADULT EPILEPSY TREATMENT OPTIONS
The main treatment options for people with epilepsy are medications, surgery and vagus nerve stimulation.
Some patients will manage their epilepsy very well with medication while others will be better served by having surgery or using vagus nerve stimulation.
Medications
Each antiepileptic medication has benefits and side effects, and different medications are appropriate for different types of epilepsy.
No one medication is proven to be the best treatment for epilepsy.
Which antiepileptic medication will work best for each patient, can be determinated only after complete examination and determination of the type and severity of epilepsy.
Surgery
Candidates for surgery are those patients who don't show good responce to antiepileptic medications.
Patients who have partial seizures that originate in one part of the brain may be candidates for surgery to remove that part of the brain.
This surgery is done only if it does not jeopardize normal function, and the part of the brain from which the seizure originates can be precisely pinpointed.
One type of surgery, awake brain surgery, allows neurosurgeons to remove seizure hotspots while keeping the patients awake to test functions such as speech and movement.
It is important to know that patients who have generalized seizures are not usually candidates for surgery.
But in case the seizures are resulting in falls and injuries, a procedure called "corpus callosotomy" may be considered.
Corpus callosotomy involves separating the nerve fibers that connect the two halves of the brain. While this surgery does not cure epilepsy or completely stop seizures, it can reduce the number and severity of seizures and the related falls and injuries.
Vagus Nerve Stimulation (VNS)
Vagus nerve stimulation (VNS) is approved to treat partial seizures in patients 12 years of age or older.
VNS can in some patients reduce seizures in frequency and intensity.
Approximately 30 to 50 percent of patients can be expected to have less seizure activity with VNS.
The vagus nerve stimulator is surgically implanted under the skin in the chest.
The surgery requires a one-night stay only for most patients. The device is attached to a wire that is tunneled under the skin and attached to the vagus nerve, which is located in the left side of the neck.
The vagus nerve stimulator is adjusted to automatically stimulate the vagus nerve from every few seconds to every few minutes.
The patient or caretaker can also turn the stimulator on by using a magnet.
The device does not detect seizure activity.
It can be adjusted easily in a physician's office using a laptop computer.
Ketogenic Diet
The ketogenic diet is primarily used in childhood epilepsy. See Treatment of Children with Epilepsy
While many people can control their seizures effectively with medication, about 30 percent don't benefit from medication because of a lack of seizure control or side effects of the medication, or both. For many of these people, surgery is the best option for relief.
During a typical epilepsy surgery, surgeons remove the portion of the brain that is causing the seizures.
While the procedure is relatively safe and quite effective, finding the exact location of the electrical misfiring in the brain that causes seizures can be extremely challenging.
Historically, the tests used to look for epilepsy "hot spots" often have been inconclusive or vague. When this occurs, one option in severe cases has been to remove most or all of one side of the brain to ensure removal of all the seizure hot spots. This radical surgery can leave serious mental and physical disabilities. In other cases, when physicians have been unable to pinpoint the hot spot, the patients have not been able to have surgery.
SISCOM and Epilepsy Surgery
SISCOM (Subtraction Ictal SPECT Co-registered to MRI) uses proven imaging technology with computer software to pinpoint seizure hot spots.
Traditionally, physicians have compared two SPECT (single photon emission computed tomography) scans of the brain: one taken during a seizure and one while seizure-free. The goal is to compare the two scans and find out where seizures are originating.
Differences between the two SPECT scans are very difficult to detect with the human eye. In response, physicians and scientists developed a computer software program that electronically subtracts one image from the other, leaving a clear picture of the seizure hot spot.
Next, the subtracted image is superimposed onto an MRI scan of the patient's brain so that neurosurgeons can verify the hot spot's anatomic location and remove it safely.
SISCOM can be used for patients of all ages, and has allowed some operations that may not have been possible before. |
| Patient preparation: Epilepsy Treatment |
Diagnosis
Careful evaluation by a child neurologist with appropriate EEG and MRI studies can help define the seizure type(s) and epilepsy syndrome. The Video-EEG monitoring unit at Mayo Eugenio Litta Children's Hospital helps pinpoint seizure onset, allowing surgeons to more easily target areas for surgery.
The vagus nerve stimulator requires surgical procedure in which stimulator is placed under the skin and this is usually done as one-night stay in hospital.
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| Recovery: Epilepsy Treatment |
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| Note: Epilepsy Treatment |
| Other conditions may be confused with epilepsy, such as syncope and stroke. |
| Conditions: Epilepsy Treatment |
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| Common Synonyms: Epilepsy Treatment |
| Epilepsy Management, Treatment of epilepsy, Seizure disorder treatment, Child epilepsy treatment, Medications in epilepsy treatment, Medications for epilepsy, Antiepileptic medications, Ketogenic diet, Surgical epilepsy treatment, Awake brain surgery, Corpus callosotomy, Vagus Nerve Stimulation, VNS, Treatment of Children with Epilepsy, SISCOM, Epilepsy Surgery |
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