Epilepsy Treatment Plans Customized to Each Patient’s Needs

The majority of people diagnosed with epilepsy can be effectively treated with medication and it is often the first therapy prescribed. There are many different epilepsy medications available, and our specialists are well-versed in the benefits and side effects of the epilepsy medications currently available. The different types of medications include:

• Medications Directed at Certain Types of Seizures: There are many kinds of anti-seizure medications, just as there are many types of seizures. Most of the newer medications are expected to help with several different kinds of seizures. Other medications are especially helpful for a particular type of epilepsy, when compared to others. Your doctor can explain how each of them helps to prevent seizures.
• Medications Directed at Certain Types of Chemicals in the Brain: Medications prevent seizures by changing the activity of different cells and the chemicals they produce in the brain. This can be done by either allowing or stopping different parts of their function. In doing so, the medications may block the process that usually causes a seizure to take place.
• Medications Used for Rescue: These medications are only given as a one-time dosage in a seizure emergency. Seizure emergencies are prolonged seizures or clusters of seizures.
• Medications Used as Daily Treatment: To prevent seizures from happening, these medications need to be taken every day to keep a steady amount of medication in your blood at all times.

Some patients are more prone to epilepsy medication side effects, including elderly patients and pregnant women. Future moms may also have an increased risk of seizures, and depending on the medication, there may be an elevated chance for birth defects. At University Hospitals, our team takes a multidisciplinary approach to effective epilepsy management for expectant moms by bringing together a team of specialists. For women with epilepsy that are considering starting a family, or are already pregnant, our high-risk maternal fetal medicine specialists are part of your care team.

If your medications are not managing your seizures effectively, you may be referred to the UH epilepsy monitoring unit (EMU) that uses advanced technology to continuously monitor brain activity. EMU patients either stop taking or reduce their dose of anti-seizure medications to induce a seizure in a medically supervised, safe environment. This helps our experts gather more information about your disease, including where in the brain seizures are occurring. Our team then pursues more targeted therapy ranging from different medications to possibly surgery.

When antiepileptic drugs are ineffective or cause intolerable side effects, surgery may be an option. Brain surgery to treat epilepsy involves the removal of seizure-producing areas of the brain. However, depending on where the seizures originate in the brain and other factors, many people with uncontrolled epilepsy are not good candidates for surgery. Additionally, many people do not choose epilepsy surgery due to the risk of subsequent neurological deficits (loss of memory, language, or other functions).

The good news is there are procedures available that can effectively treat epilepsy and reduce the number of seizures - and even possibly leave the patient seizure free – with limited loss of memory. University Hospitals is one of only a few facilities in the country that has the expertise to perform multiple hippocampal transection. Unlike traditional epilepsy procedures, this treatment can limit the spread and synchronization of seizures while leaving the brain intact. For many patients, this procedure can completely eliminate seizures and significantly improve quality of life.

Before any procedure, our neurosurgery team uses the latest imaging technology to make sure we have a clear vision of the surgical area, increasing the likelihood of a positive outcome. We also provide advanced surgical theater technology, allowing our neurosurgeons to discuss the procedure with patients during a virtual reality walk through of a 3-D simulation of their brain.

Our virtual reality technology eases patient concerns by allowing a visualization of the details of their specific brain surgery – before it happens. Through an interactive discussion between patient and surgeon, patients better understand what to expect before, during and after surgery.

Another surgical option for epilepsy patients is ROSA One Brain, a surgical navigation and positioning system that uses robotic technology to help surgeons plan and perform complex yet minimally invasive neurosurgical procedures for treating epilepsy, movement disorders and brain tumors.

ROSA One Brain allows surgeons to place instruments in the brain without having to open the patient’s skull (craniotomy) or even shave a patient’s head, as required with other traditional methods of neurosurgery. The system reduces operating times by half (or more) and improved surgical accuracy and outcomes.

The vagus nerve stimulator is a small battery-powered device, similar to a pacemaker, which is surgically placed in the upper left chest wall and attached to the left vagus nerve via two electrodes (thin wires). Once in place, the device sends electrical signals to the vagus nerve in a pattern that is selected by the patient’s epilepsy doctor and activated through a special hand-held computer. Depending on its usage, batteries must be replaced every three to five years.

Current studies show that the VNS may decrease seizures by up to 50 percent in about half of patients using this therapy. VNS has been shows to be safe in patients 12 years of age and older who have partial seizures but do not respond to medication and are not candidates for epilepsy surgery. No serious side effects from VNS have been reported.

Now available at University Hospitals, the NeuroPace® RNS® System is the next generation of implantable devices for seizure management. The device monitors the brain’s electrical activity at the seizure source and when abnormal activity is detected, electrical stimulation is delivered directly to that area of the brain. This closed-loop system is designed to normalize the brain’s abnormal electrical activity before the patient has a seizure.

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The physician scientists at University Hospitals are involved in ongoing research studies to find new and better ways to treat epilepsy. Therefore, some patients may be offered the opportunity to participate in a clinical trial as part of their total treatment plan.