By: Umang M. Shah, MD, Aurora Health Care

Epilepsy. If you’re not familiar with this disorder, it’s pretty common. In fact, one in 26 of us will be diagnosed with epilepsy. About 150,000 Americans are diagnosed with the condition every year.

What Is Epilepsy?

Epilepsy is a brain, or neurological, disorder that causes people to have recurring seizures. The condition is caused by nerve cells in the brain that begin to misfire or send out the wrong signals. This can happen because of an imbalance of chemicals in the brain called neurotransmitters, because of a change in brain cells called channels or a combination of other changes in the brain’s signals. These signal problems are what cause seizures.

The brain changes can result from a head injury, a brain infection, a stroke or a blood vessel disease. It can also be congenital. If you have a family history of epilepsy, you have a higher risk for the condition.

Epilepsy seizures can range from mild to severe. During a seizure, the person may feel strange sensations or emotions. They may momentarily stare into space and be unaware of their surroundings. Some people may even lose consciousness during a seizure or gets body shaking.

What If Someone Is Having a Seizure?

If you witness a seizure:

• Ease the person to the floor.
• Turn the person onto one side and loosen clothing around the neck for easier breathing.
• Put something soft under her or his head to serve as a pillow.
• Move hard objects away from the patient for safety.
• Remove eyeglasses.
• Time the seizure. If it’s longer than 5 minutes, call 911.

Seizures can have causes other than epilepsy. About one in 10 people has had a seizure of some type.

What’s the Treatment for Epilepsy?

We don’t have a 100 percent cure for epilepsy yet, but we can control most cases.

Once a clinician has diagnosed epilepsy, it’s best to start treatment as soon as possible. We have a number of treatment options.

Medications

After diagnosis, your clinician will likely start you on a medication to help manage seizures. To choose the best option, your clinician will review other medical conditions you may have, your age, sex and your seizure type and frequency. Based on your individual situation, the clinician may recommend:

• Most patients become seizure free or can reduce the frequency and intensity of seizures by following the recommended medication plan. Many patients have treatment success with one medication. Others may need a combination of medications for satisfactory results.

Diet Changes

A diet change can be effective in reducing seizures, especially in children. As a first treatment option or a complement to a medication, your clinician may recommend a diet that’s low in carbs and high in certain specific fats. It’s called a “ketogenic” diet or a low glycemic diet. It’s important to get professional guidance before starting and while following this type of diet.

If medications and diet changes aren’t sufficient, your clinician may suggest other options such as neurostimulation or surgery.

Neurostimulation

Neurostimulation (using devices to treat epilepsy) is an acceptable way of treating seizures in people with refractory epilepsy. It’s usually considered in people who are not appropriate for epilepsy surgery or when surgery is not helpful. With neurostimulation, the goal is not complete seizure control, but a reduction in seizures and their consequences.

There are several types of neurostimulation currently approved by the U.S. Food and Drug Administration (FDA) to treat epilepsy.

• Vagus nerve stimulation (VNS)
• Brain-responsive neurostimulation (RNS system)
• Deep Brain Stimulator

Surgery

Surgery is not for every patient. It’s an option only if your seizures originate in a part of the brain that does not have a role in functions such as speech or movement.

During the surgical procedure, the surgeon may:

• Isolate or remove the small section of brain tissue that’s triggering the seizures. The tissue removed is typically damaged in some way, or it may be a tumor. This approach is called a lesionectomy or focal resection.
• Sever a connection in the brain called the corpus callosum. This stops the nerve misfires from jumping from one side of the brain to the other. The corpus callosotomy procedure may not stop seizures, but they usually become less severe.
• Use a laser to destroy specific damaged cells or a tumor in the brain that may be causing seizures. This procedure is called laser interstitial thermal therapy (known as LITT).
• Implant a small device that can stimulate specific nerves. The stimulation can stop seizures. Two options for this approach are vagal nerve stimulation (VNS) and responsive neurostimulation (RNS). Most patients who have the implant also take a medication, but they may find a smaller dosage is more effective after the procedure.

About 50-70 percent of patients diagnosed with epilepsy are able to control their seizures with one of the techniques we’ve described.

If you have concerns about epilepsy, see your primary care provider. Your clinician may refer you to a neurologist who is specially trained to treat epilepsy.