Many
patients whose epilepsy responds poorly to antiseizure medications (20-30% of the
three million American epilepsy population) may benefit from non-drug
treatments. A study presented at the 71st American Epilepsy Society
Annual Meeting showed evidence that Vagus Nerve Stimulation (VNS), the
ketogenic diet and a surgical procedure―corpus callosotomy—may reduce generalized and focal seizures. Among patients who failed three
anticonvulsive medications between ages 8 months to 20 years, with a mean age
of 10 years, underwent one of these treatments. Most of the patients’ parents
were pleased with the results.1 Sixty-three percent of patients who
went on the ketogenic diet reported 50% or greater reduction of their generalized seizures. Fifty-four percent of
patients who underwent corpus callosotomy and 52% of patients who received
vagus nerve stimulation reported 50% or greater reduction in their generalized
seizures.
A
very important benefit in withdrawing multiple anticonvulsive medications is
that drug side effects are minimized: drowsiness, poor concentration, weight
control problems, blood testing, teratogenic risks for women among other
effects.
- Vagus Nerve Stimulation is sometimes referred to as a "pacemaker for the brain." A stimulator device is implanted under the skin in the chest. A wire from the device is wound around the vagus nerve in the neck. A person with a VNS device is usually not aware it's operating.
- The ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is extremely strict, with calorie, fluid, and protein measurements. Ketones are formed when the body uses fat for its source of energy. The body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. Higher ketone levels often lead to improved seizure control but the precise reason is not understood.
- Corpus callosotomy The corpus callosum is the most important connection between the two halves of the brain. Callosal surgical sectioning is quite effective in reducing seizure frequency in patients who have generalized epilepsy with drop attacks. It is generally reserved for this selected population. It is an epilepsy surgery procedure that is considered palliative only. It mediates communication between the two hemispheres of the brain. Seizures may spread rapidly from one hemisphere to the other by way of the corpus callosum; thus seizure spread is reduced and control is increased. Serious complications are exceedingly rare.
Dr.
Dave Clarke, Clinical Director of Epilepsy at Texas Children’s Hospital at the Baylor
College of Medicine in Houston led a study with colleagues at the Dell
Children’s Medical Center in Austin between January 2010 and November 2015.
They compared seizure control, cognitive and behavioral factors, quality of
life and parental satisfaction.
Parents
reported a 50%, or greater, reduction in generalized seizures in 63% of patients
who went on the ketogenic diet, 54% of patients improved who underwent corpus callosotomy
and 52% of patients improved who received VNS.
“Many
doctors keep trying medications without considering alternatives,” said Dr.
Clarke. He suggests doctors introduce treatment alternatives after two
anticonvulsive medications fail to control seizures.
1.
www.neurologyreviews.com: Jack Remaly in Neurology Reviews. January 2018, page 1, 45-46.
