NEW Treatment Options to Medication-Resistant Epilepsy in 2023
Epilepsy is a neurological disorder, manifesting most commonly as seizures due to abnormal electrical activity in the brain. While antiepileptic medication remains the mainstay for treating epilepsy about 1/3 rd of the patient population does not respond to it. Hence, healthcare professionals have researched alternative treatment modalities to medication. Here we will discuss the newest epilepsy treatments introduced so far.
1. Ketogenic Diet
Research shows the Ketogenic Diet (KD) is a valuable addition to treatment in children and adults with refractory epilepsy. The KD consists of a high-fat and low-carbohydrate and protein diet, with restricted calories and fluids.
This diet mimics the starvation state where the body is forced to burn fats as the primary fuel source and form ketone bodies. Ketosis alters blood acidity and helps with your seizures significantly.
The KD however, can be unpalatable for some individuals and can cause side effects like weight loss, reduced growth in children, stomach upset, and kidney stones. It is also not recommended for
certain individuals who have specific enzyme deficiencies.
Therefore, always consult your doctor before commencing a KD.
2. Epilepsy Surgery
Surgical treatment for epilepsy is an exciting new avenue. Focal epilepsy occurs due to abnormal electrical discharge in one diseased/damaged point in the brain. The focus can have a scar (yes, your brain can have scars too!), a bunch of malformed cells, or any other lesion.
Your doctor will perform a series of tests first and if it is safe to do so they will perform surgery to remove the diseased point in the brain. This shows a dramatic reduction in seizures. These patients may have to continue antiepileptic medications, but, there is a chance of reducing medications and even stopping the medication if there are no seizures for a long time!
Laser Surgery
An even more exciting option to remove the damaged or diseased focus in the brain is laser surgery using Laser Interstitial Thermal Therapy or LiTT. This is especially attractive as we don’t need to cut through the skull and brain tissue as in conventional surgery.
In laser surgery, a laser probe as small as a pencil head is used to perform the surgery through an incision that’s only 3 mm in length.
Laser surgery has its limitations too- if the lesion is too big we cannot remove it with laser, if multiple areas of the brain are affected we cannot remove it with laser surgery, it is not widely available and not many doctors are trained to perform it. However, the future is optimistic with many studies underway for laser surgery as a treatment mode for temporal lobe epilepsy and other types too.
3. Neuromodulation
Neuromodulation involves electrically stimulating the brain to modulate brain activity. This provides relief from seizures and is done through multiple options.
Vagus Nerve Stimulation (VNS)
This is the least invasive method. The left vagus nerve is repeatedly stimulated via implanted electrodes, which in turn causes changes in the electrical activity of the brain. This is effective for patients with intractable seizures. The wires are connected to the left vagus nerve in the neck and threads under the skin to be connected to the battery that is placed in the chest under the left clavicle.
Deep Brain Stimulation (DBS)
In DBS an electrical impulse is sent to deep brain structures, via implanted electrodes connected to a pulse generator, that regulates the abnormal impulses.
The thalamus is one such deep area in your brain that acts as a relay station to transmit impulses to the cerebral cortex, like a hub in the downtown metro station through which all trains pass. Both sides will be stimulated via tiny wired and these go out of the skull and get connected to the battery in the chest.
Responsive Neurostimulation (RNS)
RNS uses a device implanted in the skull and connected with wires to the brain that will detect abnormal electrical brain activity and treat it. The RNS device is smart, it reads the brain wave pattern over time and learns to identify the seizure pattern. Then it will send an impulse to stop it as soon as the seizure pattern starts, all without any outside intervention.
Essentially, they prevent seizures before they occur much like a pacemaker treats abnormal heart rhythms. This treatment modality is currently only available in the USA, and it will be licensed for use outside the United States soon.
There are many new treatment options available to manage epilepsy besides anti-epileptic medication. Always remember to consult your doctor before trying any new treatments.