Epilepsy Treatment

Let’s Learn about Epilepsy Treatment

Facts about Epilepsy •

Epilepsy affects 2.7 million Americans, more Americans than cerebral palsy, multiple sclerosis and Parkinson’s Disease combined. Approximately 200,000 new cases of epilepsy occur each year. Everyone's brain has the ability to produce a seizure under the right conditions. Epilepsy can develop at any age. However, it is diagnosed most often before the age of 20 and after the age of 60. With the appropriate treatment, up to 70% of people with epilepsy could be seizure free. Only a few percent of people with epilepsy are affected by flashing lights– this is called photosensitivity. The Greek philosopher Hippocrates (460-377 BC) was the first person to recognize that epilepsy starts in the brain. Ten percent of the American population will experience a seizure at least once in their lifetime. 1 person in 20 will have a seizure at some time in their life

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Source: http://www.epilepsynse.org.uk/PAGES/info/leaflets/epfacts.cfm

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Classification of seizures Seizure Classification Partial

Generalized

seizure activity starts in one area of the brain

seizure involves whole brain & consciousness is affected

Simple

Complex

Retains awareness

Altered awareness and behavior

Secondary generalization

(spreading from one area to the whole brain)

Tonic Clonic “grand-mal” or convulsion Loss of consciousness, stiffening of body then jerking of limbs

Absence “petit mal” or starting fit or trance like state

Source: http://www.epilepsy.org.au/fact_sheets/seizure%20Classsification.pdf

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Tonic or Atonic ‘drop attack” Abrupt fall, either with stiffening (tonic) or with loss of muscle tone (atonic or “astatic” attacks)

Myoclonic Sudden muscle jerks

Prevalence of seizure types Generalized tonic clonic, 23%

Simple Partial, 14%

Other generalized, 8%

Partial unknown, 7%

Complex Partial, 36%

Absence, 6% Myoclonic, 3% Unclassified, 3%

Source: www.med.uc.edu/neurology/epilepsyinfo.htm

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Types of epilepsy (I) Partial epilepsies

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Generalized idiopathic epilepsies

These are epilepsies with a clearly defined focal area within the brain. As a result, they have high characteristic symptoms, such as visual hallucinations, or motor difficulties on one side of the body

Generalized epilepsies are those which have no defined focal area within the brain. Idiopathic is a medical term meaning that there is no clear environmental cause for the epilepsy and it is presumed that genetic factors predominate

Types of Partial epilepsy •Benign occipital epilepsy •Benign rolandic epilepsy •Frontal lobe epilepsy •Occipital lobe epilepsy •Mesial temporal lobe epilepsy •Parietal lobe epilepsy

Types of Generalized idiopathic epilepsy •Benign myoclonic epilepsy in infants •Juvenile myoclonic epilepsy •Childhood absence epilepsy •Juvenile absence epilepsy

Source: http://www.mynchen.demon.co.uk/epilepsy/Types/Types%20of_epilepsy.htm

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Pathophysiology (I) •Normal brain function involves "communication" between millions of nerve cells (neurons) •A nerve cell is made up of a cell body and branches called axons and dendrites which join other neurons at junctions called synapses •At any one time, there are nerve cells which are resting, exciting or inhibiting other nerve cells •Electrical signals are sent from the cell body along the axon to the synapse, these electrical signals being the result of ion (Na+, K+ , Ca2+) currents across channels in the nerve cell membrane •Chemical signals (neurotransmitters) pass across synapses between neurons

Source: edycsepilepsy.intnet.mu/how_epilepsy.html

library.thinkquest.org/J001619/history.html http://www.rch.org.au/cep/treatments/index.cfm?doc_id=3242#more_pics 6

Pathophysiology (II) •Neurotransmitters cross the synaptic gap between neurons and fix to receptor points of the adjoining neuron •Some neurotransmitters function to excite the joining neuron (eg. glutamate) to send a further electrical signal. Other neurotransmitters function to inhibit the joining neuron (eg. GABA) and inhibit electrical signals passing down that neuron •It is by these electrical and chemical pathways that the millions of neurons within the brain communicate and function normally •seizures occur when there is an imbalance within these excitatory and inhibitory circuits in the brain, either throughout the brain (generalised epilepsy) or in a localised part of the brain (focal epilepsy), such that neurons fire off in an abnormal fashion •Mechanism of AEDs to prevent –Altering electrical transmission along neurons by affecting ion (Na+, K+ , Ca2+) channels in the cell membrane. –Altering chemical transmission between neurons by affecting neurotransmitters (GABA,glutamate) in the synapes

Source: http://www.rch.org.au/cep/treatments/index.cfm?doc_id=3242#more_pics

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Treatment Options • There are four main categories of epilepsy treatments – Ø Medications

Ø Ø Surgery

Ø Ø Ketogenic Diet

Ø Ø Vagus Nerve Stimulation Source :http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm

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Medications • Each medication has benefits and side effects and different medications are appropriate for different types of epilepsy.

• • No one medication is proven to be the best treatment for epilepsy. Only a complete evaluation can determine which medication will work best for each patient.

• • Approximately

• – 50% of seizures are eliminated by medication

– – 30% of seizures are reduced in intensity and frequency by medication Source: http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm 9

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Seizure type and Drug selection Seizure type

First line drugs

Partial (simple, complex, with or Lacosimide Leveiiracetam without secondary Carbamazepine generalisation Sodium valproate

Generalized absence

Sodium valproate Ethosuximide

Generalized tonic-clonic

Levetiracetam Sodium valproate

Second line drugs Clobazam Clonazepam Gabapentin Lamotrigine Phenytoin Tiagabine Topiramate Vigabatrin Pregabalin Zonisamide Clobazam Clonazepam Lamotrigine  

Carbamazepine Clobazam Gabapentin Lamotrigine Phenytoin Topiramate Vigabatrin  



Myoclonic

Leveitiracetam Sodium valproate



Phenobarbital

Source: http://www.pjonline.com/Editorial/19990327/education/epilepsy_treatment.html

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Surgery

lve removal of epileptogenic tissue from the area where seizures arise or interruption of nerve pathways alon

nd Cortical Resection Hemispherectomy most common form of epilepsy surgery is a lobectomy or cortical resection. •The operations usually involve removal of a relatively small area of the brain s part of a left or right lobe may be removed surgically

Source:http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm

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Surgery Multiple Sub- pial Transection •This operation also seeks to control seizures by cutting nerve pathways •It is used when the seizure focus is located in a vital area of the brain that cannot be

to identify a single epileptic focus but leaves some connections in place. If the generalized seizures stop, no further surgery is done. If they continue, a

Source: http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm

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Ketogenic Diet • The ketogenic diet is primarily used in childhood epilepsy.

• • The mechanism of ketogenic diet is unknown. The high-fat, low-protein, no-carbohydrate diet mimics some effects of starvation that seem to inhibit seizures.

• • The diet is very rigid and carefully controlled and must be supervised by a physician -- sometimes in a hospital setting.

• • Ketogenic diets have been used for children with epilepsy for many years with a success rate of approximately 50 percent. Source: http://www.mayoclinic.org/epilepsy/index.html

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Vagus Nerve Stimulation (VNS) •Vagus nerve stimulation (VNS) is approved to treat partial seizures in patients 12 years of age or older •Approximately 30 to 50 percent of patients can be expected to have less seizure activity with VNS •The vagus nerve stimulator is surgically implanted under the skin in the chest. The device is attached to a wire that is tunneled under the skin and attached to the vagus nerve, which is located in the left side of the neck •The vagus nerve stimulator is adjusted to automatically stimulate the vagus nerve from every few seconds to every few minutes. •The device does not detect seizure activity. It can be adjusted easily in a physician's office using a laptop computer

Source:http://www.mayoclinic.org/epilepsy/diagnosis.html

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