Blog #121: IF YOUR SEIZURES AREN’T CONTROLLED EPILEPSY SURGERY IS SAFE AND REALLY CAN HELP

I have addressed epilepsy surgery before in several of my 120 monthly epilepsy blogs published at LanceFogan.com since 2011. Evidence is overwhelming that epilepsy surgery, if you are a candidate, is safe and can be tremendously beneficial in reducing, or even, curing your epilepsy.

 

The chief research officer and epilepsy specialist at Cleveland Clinic, Lara Jehi, MD, detailed the patient-centered pros and cons associated with epilepsy surgery, as well as the stigmas related to it. “Even before you put a patient through the surgical testing, neurologists have to identify if they’re a surgical candidate. The most cost-effective option is to send them to get that evaluation.” Jehi hopes that her study can help demystify some of the preconceived notions that surround epilepsy surgery. NeurologyLive /www.neurologylive.com/videos/lara-jehi-md-pros-and-cons-of-epilepsy-surgery.

 

A recently published study that evaluated costs found epilepsy surgery was cost effective ($328,000) compared to medical management ($423,000) in surgically eligible patients and more effective (measuring Quality Adjusted Life Year of 16.6 vs. 13.6 QALY) than medical management in the long run. The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived.¹

 

The data has potential to raise eyebrows within the epilepsy community, and ultimately sway more patients to not only get the surgery, but to at least have their own surgery-eligibility evaluated. Dr. Lara Jehi feels that patients don’t fully understand the benefits that come with epilepsy surgery. She encourages those eligible to at least consider surgery knowing their less-than-effective anti-seizure medication will probably not improve their quality of life.

 

“There are a lot of fears out there. Some justified, but some due to misperception and misinformation that may stop someone from getting to the point of looking at brain surgery.” Jehi provides insight on the truth behind the stigmas related to epilepsy surgery and whether patient fears are legitimate. In the above video Jehi discusses moms worried about weeks long hospitalizations for testing, other family responsibilities during that time; time off work; relatives with past complications due to other types of surgeries.

 

Her study results confirm the positives of surgery. Epilepsy surgery is underutilized and not recommended to a large number of patients by their neurologists despite multiple studies proving its effectiveness and long-term benefit with drug-resistant temporal lobe epilepsy. Jehi hopes that her study can help demystify some of the preconceived notions that surround epilepsy surgery.

 

1. Sheikh SR, Kattan MW, Steinmetz M, Singer ME, Udeh BL, Jehi L. Cost effectiveness of surgery for drug resistant temporal lobe epilepsy in the US. Neurology. Published online July 8, 2020. doi: 10/1212/WNL.0000000000010185

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

 

 

Blog #80: How Epilepsy Patients Use Herbal and Botanical Therapies

            In NEUROLOGY NOW, February, 2017, page 12, Dr. Dana Ekstein, senior neurologist at Hadassah Medical Center in Jerusalem, reviewed the use of non-prescribed chemicals and herbs that epilepsy patients use to help control seizures, to treat medication side effects, and to treat their anxiety, depression and memory problems.

            A 2012 American Health Interview Survey revealed about eighteen percent of the American population use complementary herbal and botanical medicines other than vitamins, and nonmineral natural products. Among people with epilepsy half of adults and a third of children use complementary therapies without their physicians’ knowledge. Some of these botanicals interfere with their prescribed antiseizure medications.

 

            Another study, a Canadian study ¹, found that fifty-nine percent of patients with epilepsy and thirty-three percent of patients with psychogenic non-epileptic seizures (see my Blog #10: September 23, 2011 Is It A True Epileptic Seizure or a Faked, Psychogenic Seizure With a Psychological Cause?) who participated in the study and who used cannabis, i.e., marijuana, hashish, “pot,” etc., daily perceived improvements in seizure control, stress, sleep quality, and drug side effects. Although their perceived stress reduction may have contributed to the perceived positive impact of marijuana on seizures and nonepileptic events in adults, the researchers reported that they could not reliably conclude that Cannabis was objectively efficacious.

            A Cochrane Review (Cochrane works collaboratively with contributors around the world to produce authoritative, relevant, and reliable evidence in the form of Cochrane Reviews) of cannabinoids for epilepsy found no reliable conclusions could be drawn regarding the efficacy of the studied doses of 200-300 mg daily of cannabidiol component of the marijuana plant (the non-psychoactive component of marijuana plants in contrast to the psychoactive tetrahydrocannabinol [THC] component) ². Further trials are needed in this area.     

            Another trial led by Devinsky et al ³ concluded that of 137 patients with onset of drug-resistant epilepsy beginning in childhood and currently experiencing at least four seizures per month, thirty-nine percent enjoyed a fifty percent, or greater, reduction in seizure frequency.

            Regarding the treatment of depression in epilepsy with botanicals a Chinese mushroom called Xylaria nigripes was studied in a random, double-blind, placebo-controlled trial of one hundred four patients. The mushroom-treated patients reported significantly improved depression and quality of life scores compared with placebo ⁴.

           One must use caution in assuming that natural products are safe. Ephedra, St. John’s wort and ginkgo biloba can cause seizures. Tetrahydrocannabinol [THC] may impair memory and executive function and induce psychiatric symptoms. Other unwanted side-effects in cannabis trials include worsening seizures, drowsiness, fatigue, and gastrointestinal complaints. 

            Interactions s between antiseizure drugs and botanicals can include altered blood levels of the antiseizure drugs (cannabidiol increases concentrations of clobazam).

            Dr. Eckstein emphasizes that neurologists need to be well-educated and up-to-date regarding botanical therapies.

1)    Massot-Tamis A, McLachlan RS. Marijuana use in adults admitted to a Canadian epilepsy monitoring unit. Epilepsy Behav. 2016; 63: 73-78.

2)    Gloss D, Vickrey B. Cannabinoids for epilepsy. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD009270. DOI: 10.1002/14651858.CD009270.pub 2.

3)    Devinsky O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016; 15(3): 270-278.

4)    Peng WF, Wang X, Hong Z et al. The anti-depression effect of Xylaria nigripes in patients with epilepsy. A multicenter randomized double-blind study. Seizure. 2015; 29: 26-33.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.