Diagnosis & Treatment
The goal of epilepsy treatment should be “no seizures and no side effects.” Not everyone will be able to reach that goal, but doctors and patients should always be working toward it together. A strong doctor-patient relationship, access to needed treatments and healthcare services, and healthy behaviors all contribute to successful management of seizures. Epilepsy Foundation of Michigan staff can work with you to make sure you’re doing everything you can to manage your seizures.
 
Diagnosis
An accurate diagnosis increases the chances of successful treatment. Epilepsy can be confused with nonepileptic seizures and many other conditions. Doctor’s must rule out these other conditions before making a diagnosis of epilepsy. In addition, diagnosis should include information on what type of epilepsy is suspected, what type of seizures are being experienced, and what to expect in the future.
 
A variety of tools can help doctors with diagnosis, including electroencephalography or EEG (standard EEG, ambulatory EEG, video EEG monitoring), neuroimaging technologies (MRI, CT, PET, SPECT, MEG, MRS), neurological exam, physical exam, and blood tests. Perhaps the most important diagnostic tool, however, is the medical history. This provides the doctor with important information on what happened before, during, and after each seizure and can give clues regarding a possible cause.
 
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Treatment
Typically, the first treatment tried in patients with epilepsy is daily medication. There are over 20 antiseizure medications (AEDs) available. Most people with epilepsy are able to get complete seizure control by taking one ore more antiseizure medications; however, in 30 - 40% of patients, seizures continue despite treatment.
 
If you have tried two appropriate medications, and you’re still having seizures or significant side effects, you should see an epileptologist (a neurologist who specializes in epilepsy) to confirm your diagnosis, review your current treatment regimen, and discuss other treatment options. Most epileptologists work at Comprehensive Epilepsy Centers, which feature a staff of epilepsy experts, including clinical nurse specialists, neurosurgeons, neuropsychologists, and others, and access to the full array of diagnostic and treatment options.
 
In addition to medication, the following treatment options may be considered:
 
  • Brain Surgery – If your seizures are starting in a single part of the brain that can be safely removed without damaging important functions like movement, vision, or speech, you may be a candidate for brain surgery. The most common type of brain surgery removes the seizure-producing part of the brain and results in seizure freedom for the majority of patients. Although risks need to be carefully considered, surgery should no longer be thought of as a last resort. In appropriate candidates, surgery early in the course of the condition offers the best chance of becoming seizure free and maintaining quality of life.
  • Dietary Therapies – The ketogenic diet is a high-fat, low-carbohydrate diet that, for reasons not fully understood, can improve seizure control in some people with epilepsy. It must be done under the supervision of a doctor and a dietitian, foods must be carefully measured out, and rules must be strictly followed. Variations of the ketogenic diet, like the Modified Atkins Diet and Low Glycemic Index Diet, may be easier to follow while still being effective. Traditionally used only in young children, the ketogenic diet and related diets are now helping people of all ages. In addition, the ketogenic diet is now considered the first-line treatment for certain types of epilepsy, like Glut1 Deficiency Syndrome and Pyruvate Dehydrogenase Complex Deficiency, and an early treatment option for many other types of epilepsy, including infantile spasms, Rett syndrome, tuberous sclerosis complex, Dravet syndrome, and Doose syndrome.
  • Vagus Nerve Stimulation – Patients who are not candidates for brain surgery and for whom medication is not working may consider vagus nerve stimulation. A vagus nerve stimulator (VNS) is a pacemaker-like device implanted under the skin on the chest wall with leads that attach to the vagus nerve in the neck. The device is programmed to periodically stimulate the brain via the vagus nerve. For some people, this reduces the frequency or severity of seizures. It also offers an added sense of control because a magnet that comes with the device can be used to activate it if an aura is experienced or if a seizure has already begun. This can sometimes prevent, stop, or shorten a seizure. The newest models provide responsive stimulation when a sudden increase in heart rate is detected (seizures are often associated with such changes in heart rate). It is uncommon for people to become seizure-free by using the VNS; however, it can often improve seizure control and/or quality of life.
  • Responsive Neurostimulation - The Responsive Neurostimulation System (RNS System) by NeuroPace monitors electrical activity in the brain and delivers stimulation to the seizure focus when the onset of a seizure is detected. This can sometimes prevent a seizure before it happens.The RNS neurostimulator is embedded in the skull under the scalp, and one or two leads are placed within or on the surface of the brain. The device's detection and stimulation settings are customized for each individual patient and can be adjusted based on the continuously recorded data. This treatment may be helpful for people with one or two seizure foci.
  • Deep Brain Stimulation - The Deep Brain Stimulation (DBS) device provides periodic stimulation to a deep structure of the brain called the thalamus that is thought to be involved in the initiation and spread of seizures. The components include a neurostimulator device implanted under the skin on the chest wall and leads placed into both sides of the thalamus. For many, the device reduces seizure frequency and severity.
  • Complementary Therapies – Several other promising therapies for epilepsy have been studied but don’t yet have enough evidence to support their routine use; however, if your doctor agrees that a therapy is safe, affordable, and possibly effective, it might be worth trying in addition to your standard treatment. Keep in mind, several therapies that claim to help with seizures can actually make seizures worse, interfere with antiepileptic medications, and cause other health problems.
 
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