Anti Epilepsy Drugs AED's

The most commonly used treatment is medication. There are many anti-epileptic medications available and they have varied uses. Read more..

The Ketogenic Diet

The Ketogenic Diet is a treatment most commonly offered to children. Read more..

Surgery

In certain circumstances, when other therapies fail to work, surgery may be an option. Read more..

Vagus Nerve Stimulator (VNS)

The Vagus Nerve Stimulator involves a minor operation and an implant and can be an effective means of controlling seizures. Read more..

The Ketogenic Diet

 

The diet is an epilepsy treatment mainly used in children. The diet was first developed in the early twentieth century and was very successful. It was phased out by the development of anti-epileptic drugs later in the century but is enjoying something of a comeback in recent years.

 

The diet is a long process; it is not a quick fix or a weight loss programme. It is based on a high fat, adequate protein and low carbohydrate formula. Candidates for the diet are typically children with difficult to control epileptic seizures.

 

How the Ketogenic Diet works

 

The diet itself consists of three food groups: unrestricted, fatty and restricted. Unrestricted foods include certain vegetables, unsweetened fruit and artificial sweetener. Fatty foods include bacon, cream, mayonnaise and nuts. Restricted foods include items containing sugar. The diet begins with a fasting period of 24-48 hours, this is sometimes done on an in-patient basis. The high fat diet then begins. The brain normally uses glucose as an energy source but in the absence of this glucose, ketones produced by the liver in the breaking down of fat are utilised. This state is known as ketosis. Whilst in ketosis the extent of ketones can be measured by urine dipstick, the aim being to achieve moderate to heavy ketosis.

 

The exact mechanism of why the diet works is not yet known. There are suggestions that the effects are related to:

 

Mild acidosis

 

Slight dehydration

 

Ketosis effects on the brain

 

The diet should be conducted under medical supervision and it is calculated on an individual basis. The general make up is 90% of calorific requirements as fat, 1 gram per kilo of body weight as protein and a minimal amount of carbohydrate. Vitamin and calcium supplements are also taken. All food is carefully weighed and menus carefully calculated. Complete commitment is vital as the diet needs to be stuck to strictly.

 

The diet is generally followed until the child has been seizure free for two years and then can be stopped. It may be restarted if seizures start again. Often, the need for anti epileptic medications is eliminated and after 2-3 years on the diet the child can recommence a normal diet and remain seizure free. Compliance seems to be the most challenging prospect of the diet but benefits such as full or partial seizure control provide excellent incentives. Statistics concerning the diet’s effectiveness vary but significant numbers of children have been helped by the diet in some way. However it is important to note it is not helpful to everyone and there are side effects such as nausea and vomiting during the fasting period, constipation and possible kidney stones due to the build up of uric acid in the blood.

Vagus Nerve Stimulator (VNS)

 

The Vagus Nerve Stimulation is an epilepsy treatment which involves a device being implanted just under the left collar bone. The device consists of a generator and three leads which coils around the vagus nerve. The vagus nerve monitors and controls the internal organs; the stimulator sends regular electrical impulses to the brain via the vagus nerve. These impulses are believed to prevent the brain from going through the seizure process.

 

VNS implantation is a surgical process. The operation takes 1-2 hours and involves two incisions, one on the left side of the neck and one on the left upper chest or armpit. A bulge might be present on the upper chest after the procedure as this is the area where the generator is implanted. The generator is programmed to automatically send an impulse along the vagus nerve intermittently but it is also possible for patients to start stimulation themselves on demand using a magnet.

 

This treatment is appropriate for people whose epilepsy has been difficult to control using anti-epileptic drugs. It is available both on the NHS and in the private health care sector. It can be used as a sole therapy or in conjunction with anti-epileptic drugs. As with anti-epileptic drugs, there are side effects. These commonly occur when the generator is actively stimulating the vagus nerve and include:

 

Tickly/sore throat

 

Change in voice tone

 

Cough

 

Shortness of breath

 

The generator will occasionally need replacing as its batteries run down; this also involves a small operation. It is important to note that VNS will not necessarily stop seizure activity altogether and its effects are not always immediate. However, studies suggest that in some cases seizures cease and in others seizures became shorter, less severe and/or less frequent. On balance it is noted that in some cases VNS therapy is ineffective.

Surgery

 

Surgery may be considered for people with epilepsy under certain circumstances. Not everyone with epilepsy is a suitable candidate for surgery and it is dependant on certain factors. The decision to undergo surgery should not be taken lightly as it is a major brain operation and can involve removing a portion of the brain. Epilepsy surgery may be an option if:

 

There are structural abnormalities to part of the person’s brain, for example scarring or lesions.

 

The seizures experienced are partial seizures, affecting one part of the brain.

 

Anti-epileptic drugs are ineffective.

 

The part of the brain to be removed is accessible.

 

The part of the brain to be removed will not adversely affect the person’s ability to maintain a good quality of life and to function normally.

 

There are no other medical problems which may be worsened or deem the person unsuitable for surgery.

 

There are various different types of surgery for epilepsy:

 

Temporal Lobectomy: a large section of the temporal lobe is removed.

 

Hemispherectomy: this can be used in severely brain damaged individuals where an entire side of the brain is affected; that side of the brain is removed.

 

Corpus Callosotomy: involves cutting fibres connecting the two halves of the brain.

 

Sub-pial Resection: cuts are made in the motor areas of the brain, fine enough to stop seizure activity but retain motor function.

 

Selective Amygdalo Hippocampectomy: two parts of the temporal lobe are removed commonly associated with seizure activity.

 

Lesion or Cyst Removal.

 

As with all epilepsy treatments, success is not guaranteed. In the case of surgery, it is possible to experience seizures after the operation due to swelling of the brain. Statistics suggest that after surgery more than 70% of people become completely seizure free and with advances in modern techniques, surgery is becoming more common in recent times. Many people who do not become seizure free as a result of surgery see a dramatic reduction in seizure activity.

 

As may be expected with brain surgery, the recovery process is not rapid. However, many people find that they are able to return to work within 8-15 weeks.

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