Epilepsy and Its Various Treatment Options

When you think about epilepsy, you most likely picture someone having a dramatic seizure, where they collapse to the ground with frightening jerking movements and loss of bodily functions. These episodes, known medically as “general tonic-clonic” seizures, or traditionally referred to as “grand mal” seizures, are just one of several different types of seizures that happen when the brain’s neurons misfire and release neurotransmitters, which occurs with epilepsy.

What is Epilepsy?

According to the U.S. Centers for Disease Control and Prevention (CDC), epilepsy is a disorder of the brain that causes a person to experience at least two seizures more than 24 hours apart. With epilepsy, there’s no apparent cause, such as medication, illicit drug activity or a metabolic imbalance, for the seizure.

Alberto Pinzon, M.D., is a neurologist with Miami Neuroscience Institute and Epilepsy Program director at Baptist Hospital which, in partnership with the Institute, was once again certified by the National Association of Epilepsy Centers (NAEC) as a Level 4 epilepsy center – the highest level of epilepsy care possible – in its most recent accreditation. Dr. Pinzon, along with a multidisciplinary team that includes Regine Narchet, R.N., ENLS Patient Care Supervisor and Epilepsy Coordinator at Baptist Hospital, all have played a role in the program’s ongoing success.

According to Dr. Pinzon, the most definitive way to diagnose epilepsy is with a video electroencephalogram, or EEG. “An EEG measures the brain’s electrical activity and the video component captures the body’s reaction to the abnormal brain activity,” he says. Some patients are able to use portable EEG monitors that track their brain activity while doing their normal daily routines at home, he adds.

Other tests may also be performed to find or rule out other causes for the seizures, he says, including:

• A neurological exam
• A blood test to diagnose hormonal imbalances
• CT scans or MRIs to find lesions on the brain that may indicate a stroke or brain tumor
• A spinal tap to rule out infection
• Wada testing to evaluate language and memory function

“These tests help us put everything together to provide an accurate diagnosis,” Dr. Pinzon says.

Epilepsy Diagnosis and Monitoring

The Epilepsy Program at Baptist Health’s Marcus Neuroscience Institute, which is part of Boca Raton Regional Hospital, has two fellowship-trained, board-certified epileptologists – neurologists who specialize in epilepsy. The Institute also has an epilepsy monitoring unit (EMU), which is used to evaluate and diagnose epilepsy and other seizure disorders.

“This is the only epilepsy monitoring unit from West Palm Beach to Fort Lauderdale,” says Pooja S. Patel, M.D., director of the Epilepsy Program at Baptist Health’s Marcus Neuroscience Institute. “During an EMU evaluation, special equipment tracks a patient’s brain activity before, during and after a seizure, which gives doctors and nurses real-time feedback about seizure triggers, length, frequency and recovery.” By monitoring seizures while they happen, she says, doctors can develop a more tailored, effective treatment plan.

Epilepsy Treatment

Once epilepsy has been diagnosed, treatment is necessary to improve quality of life and prevent disability resulting from repeated seizures. Dr. Patel says that patients benefit from new technology and treatment options are available to our patients as soon as they are approved and proven effective.

“Medications are often the first line of treatment for new-onset seizures or epilepsy,” says Dr. Patel. “However, patients with hard-to-control, or intractable, epilepsy may benefit from more advanced treatment options, including surgery and neurostimulation.”

Medication
Research has netted significant improvements in medications used to target certain areas and functions of the brain and control the different types of seizures that occur with epilepsy.

“We now have about 20 to 25 medications we can use to help manage epilepsy and other seizure disorders,” says Dr. Patel. “We may need to combine medications through trial and error to find the formula that works best, but most patients have their epilepsy controlled with medication.”

Surgical Options
For patients whose seizures fail to respond to medications, as in “medically refractory epilepsy,” surgical options exist. In addition to those patients, Dr. Patel says surgery often helps patients whose epilepsy affects one area of the brain.

Some of the surgical procedures used to treat epilepsy include laser ablation, which uses heat to destroy the area of the brain that is causing epilepsy, and resective surgery, which removes brain tissue where the seizures start.

Many patients benefit from neurostimulation, says Dr. Patel, in which a small implanted device helps reduce or prevent seizures. “Neurostimulation is a highly specialized type of epilepsy treatment that’s offered only at certain centers such as Marcus Neuroscience Institute and Miami Neuroscience Institute,” she says.

There are two types of neurostimulation treatments, according to Dr. Patel. “With Vagus Nerve Stimulation, or VNS, electrical pulses generated by a device implanted in the neck stimulate the vagus nerve and reduce seizures,” she says. “And with a Responsive Neurostimulation (RNS) device, a pacemaker-like device implanted into the skull senses abnormal brain activity and delivers electrical stimulation to the brain to actually prevent a seizure from happening.”

Dr. Patel says that these technological advances, especially in the areas of minimally invasive procedures such as VNS and RNS, are greatly improving the management of epilepsy and the quality of life for patients who undergo them.

Complementary Treatments
In addition to medical and surgical treatments for epilepsy, some patients have turned to alternative, complementary therapies that have shown promising results.

Patients with refractory epilepsy, who have adopted a strict ketogenic, or “keto,” diet, for example, have seen effective management of their seizures. Miami Neuroscience Institute’s Dr. Pinzon says that’s because the burning of fats, instead of carbohydrates, for the body’s fuel leads to changes in the metabolism of the brain. He says the keto diet can be effective if carefully followed.

Living With Epilepsy

Dr. Pinzon says it’s important to treat epilepsy to control seizures. “Our greatest fear is the risk of disability from seizures,” he said. “Seizures can even lead to death.”

He warns that the stigma associated with epilepsy must be addressed through education of patients, their families and the public. “Epilepsy is a medical condition that is manageable and treatable,” Dr. Pinzon says. “By educating others about the disease and its treatment options, as well as providing social resources to help patients and their caregivers cope with the management of seizures, we can minimize the stigma and improve patients’ quality of life.”

Dr. Pinzon says the epilepsy program at Miami Neuroscience Institute includes the most complex diagnostic techniques and surgical procedures available for epilepsy management, including 2-stage surgical procedures for epilepsy localization and treatment with resection, and non-resection options such as VNS and RNS, among others.

Equally important for the patient, he adds, is that the epilepsy program combines advanced treatment approaches with education and social management of the disorder. “At Baptist, patients have access to a multidisciplinary and comprehensive approach to epilepsy care, including optimization of medications, complete pre-surgical evaluations and the latest surgical procedures for epilepsy,” Dr. Pinzon says.

Moreover, he adds, Baptist provides psychosocial support to patients and their caregivers. Additionally, there are ongoing clinical research studies in collaboration with Florida International University Engineering department, which may provide additional opportunities to some patients with refractory epilepsy.

“Family involvement is crucial to epilepsy care,” Dr. Pinzon says. “Baptist Health’s program recognizes that and offers caregivers the support they need. We’re living in exciting times to help patients with epilepsy have normal lives.”