What Are the Top 5 Treatment Options for Epilepsy?
Epilepsy is a neurological disorder affecting about 3.4 million people in the U.S. Although it’s most common in children and adults age 65 and older, epilepsy can strike people of all ages, races, and backgrounds. In fact, an estimated 48 out of 100,000 people in America develop epilepsy every year, and one in every 26 people suffers from the disorder at some point during their lives.
Signs and Symptoms of Epilepsy
Seizures are the signature symptom of epilepsy, and other symptoms are related to the type of seizure a person suffers. Focal seizures affect only one part of the brain and may be simple or complex. Generalized seizures involve all brain areas and are classified as one of six types: absence, tonic, atonic, clonic, myoclonic, or tonic-clonic. Some people with epilepsy experience a type of seizure known as secondary generalized, in which the seizure begins in one part of the brain before spreading to other areas.
Seizures most commonly cause a change in awareness, characterized by symptoms such as confusion or staring. During a seizure, a person may experience a sense of fear or déjà vu, or he or she may express unusual emotions. Some seizures result in a complete lack of response or even loss of consciousness.
Physical symptoms are also often associated with epileptic seizures. Muscles can stiffen, causing a person to fall down, or control over muscles may be lost. Jerking of the extremities or repetitive motions, such as rubbing the hands or walking in circles, are both common. Other symptoms include neurological and sensory abnormalities like dizziness, tingling, or changes in perception. Some people experience what’s known as an aura prior to a seizure, manifesting as a light, smell, or other unusual disturbance, and are able to use this “warning signal” to prepare for the onset of other symptoms.
A seizure may be triggered by one or more lifestyle or environmental factors. Common triggers include illness, stress, drugs, alcohol, bright or flashing lights, food sensitivities, and lack of sleep. If triggers can be identified and avoided, it may be possible to reduce the occurrence of seizures.
Top Epilepsy Treatment Options
In addition to becoming familiar with triggers and auras, people suffering from epilepsy have several options for controlling the disease. Treatments range from conventional medical therapies to alternative practices still being researched.
Prescription medications are the most common treatment for epilepsy. Up to 70 percent of people experiencing epileptic seizures may be able to control or even halt seizure activity with the right drug or combination of drugs.
As with any prescription, anti-seizure medications carry a risk of side effects. Symptoms vary depending on the drug, but the most common are dry mouth, dizziness, digestive discomfort, confusion, headaches, and disturbed sleep patterns.
Patients able to adhere to a drug regimen are the best candidates for this type of treatment. It’s important to note anti-seizure drugs don’t cure epilepsy, even if seizures stop when a person is on them. Prescriptions are given as preventative measures to improve quality of life and should be continued until or unless a doctor advises otherwise.
About 30 percent of epilepsy cases fail to respond to two or more medications. Known as refractory epilepsy, this form of the disorder may benefit from surgery, especially if seizures are severe. The same risks associated with all types of surgery must be considered, including bleeding, inflammation, and infection. However, additional considerations apply because of the sensitive nature operations involving the brain.
Depending on the type of surgery performed, a person may experience the loss of some basic abilities or lose conscious control of one or more parts of the body. Focal seizures require the least amount of surgical intervention because only one part of the brain must be removed to address seizure activity. Other types of surgery are more extensive and carry a greater risk of complications or side effects.
The greatest benefit of surgery is its potential to reduce or stop all seizure activity in individuals who continue to struggle with epilepsy after trying other treatments.
Stimulating the Vagus Nerve
A less-invasive option for refractory epilepsy is vagus nerve stimulation or VNS therapy. This method is approved for adults and children ages four and over and uses a small device implanted in the chest. The device is wired to the vagus nerve, which is located in the neck, and delivers regular electrical pulses in an effort to lessen the severity and frequency of seizures. Those whose seizures are preceded by auras can pass a special magnet over the implanted device to increase electrical stimulation prior to the onset of symptoms.
Patients treated with VNS therapy may experience a 20 to 40 percent reduction in seizure activity along with improved mood, alertness, and overall quality of life, but it can be up to two years before any significant changes take place. Side effects are mild and may include coughing, a hoarse voice, or trouble swallowing.
Developed in the 1920s for children with refractory epilepsy, the ketogenic diet creates a state in the body similar to caloric restriction or starvation. Doctors at the time noticed children put on calorie-restricted diets seemed to experience fewer seizures and sought a viable way to get the same benefit on a diet with sufficient calories. They found the answer in a very high-fat, low-carbohydrate regimen.
When this balance of macronutrients is maintained, the body has little or no glucose to use as fuel and turns to an alternative called ketones to make energy. Far from being the weight loss method for which it’s currently touted, the “keto” diet at the time of its inception was one of the only ways to help children whose seizures continued even with the use of medication and is still sometimes used today.
Because of the nature of the diet, digestive issues like constipation and vomiting may occur. Some children also complain of feeling hungry or sluggish at first.
By using sensors attached to the skin to visualize automatic bodily responses, some people are able to learn to control seizure symptoms. This technique, known as biofeedback or neurofeedback, is still being studied in epileptics, but it shows promise for those seeking to improve their quality of life. The most effective form of the treatment seems to be galvanic skin response, or GSR, in which sensors measure the amount of sweat on the skin. So far, no side effects have been observed in patients using biofeedback.
For biofeedback to work, patients must partner with medical professionals who understand their medical histories and have the knowledge necessary to interpret readouts from the sensors.
Since each person’s case is unique, doctors must assess the current health status, personal needs, and expectations for the outcome with patients before prescribing a course of treatment. Potential side effects and the risk of interactions with current medications affect the viability of each option, and a patient’s capacity to stick with a regimen is also an important concern. Once a personalized treatment plan has been established along with supporting lifestyle practices, doctors and patients should work together to monitor the outcome and make adjustments to minimize seizure activity as much as possible.