How is Epilepsy Treated?

Diagnosis

Blood tests test for infections, genetic conditions, or other conditions that can cause seizures. The doctor’s initial evaluation will include a neurologic exam whereby the doctor will test your behavior and mental functions by asking simple questions and evaluating your answers. In addition, the doctor will test your motor skill abilities which can help determine which type of epilepsy you have.

Types of tests used to diagnose epilepsy

  • Electroencephalogram (EEG). The brain wave test is the most common test used to determine epilepsy. Epilepsy causes changes in standard brain wave patterns. Doctors use the EEG to record electrical activity to measure these brain waves.
    • Video electroencephalography monitoring involves a video EEG that records what you are experiencing or doing while an EEG records your brainwaves.
  • High-density EEG. This test is like the EEG test; however, the electrodes are spaced closer together. This allows the doctor to establish which brain area is more accurately affected by seizures.
  • Computerized tomography scan (CT). A CT scan uses X-rays to view a cross-section image of the brain. CT scans help discover abnormalities in the brain, such as brain bleeds, tumors, or cysts.
  • Magnetic resonance imaging (MRI). This imaging method produces detailed pictures of the brain by using magnets and radio waves to create the images. It can detect lesions or other abnormalities in the brain that could be causing seizures.
  • Functional MRI (fMRI) measures blood flow changes when specific brain parts work. Surgeons use this test before surgery to determine precisely where critical functions such as movement and speech are in the brain to avoid these areas during the operation.
  • Positron emission tomography (PET) can detect brain abnormalities by injecting a small amount of low-dose radioactive medicine into a vein. This allows the visualization of the metabolic activity of the brain. Areas of low metabolism in the brain could signify the location of the seizures.
  • Single-photon emission computerized tomography (SPECT) uses small amounts of radioactive medicine that is injected into a vein. This creates a detailed, 3-D image of the blood flow activity in the brain during a seizure. Areas with greater blood flow during a seizure can show where the seizures originate.
  • Neuropsychological tests. The doctor will ask questions to evaluate your mental functions such as thought, memory, and speech. This can help determine the origin of the seizures.

How is Epilepsy Treated?

Treatment

Anti-seizure medication (ASD) is doctors’ first go-to treatment for epilepsy. Two-thirds of patients treated with medication eventually become seizure-free. For other patients, medication, in conjunction with other potential treatments, can help a patient become seizure-free.

Adults and children who remain seizure-free for two years or more may sometimes be advised by their doctor to discontinue their anti-seizure medicine.

Anti- seizure medications can have some mild side effects:

  • Tiredness
  • Lightheadedness
  • Weight gain
  • Diminished bone density
  • Skin rash
  • Speech and memory problems
  • Coordination difficulties

Some serious side effects could be:

  • Depression and suicidal thoughts or behavior
  • Rash
  • Inflammation of organs, such as the liver

Notify your doctor if any of these side effects occur. In addition:

  • Medications should be taken as prescribed by your doctor. Never stop taking your medication unless advised by your doctor.
  • Notify your doctor if you experience depression, mood changes, or suicidal thoughts.
  • Advise your doctor of any other medications, including over-the-counter drugs or herbal supplements.
  • Report any co-existing medical concerns, such as migraines. Some anti-seizure medications can treat both seizures and migraines, eliminating the need for additional medication.

If medication is not successful in treating epilepsy, doctors usually suggest minimally invasive procedures to address the source of epilepsy. Some patients have found a decrease in their seizures when dietary changes are combined with added nutritional guidance from a registered dietician.

Advanced brain imaging tests and treatments, along with clinical trials, are available to patients who may not have been eligible for surgery.

Surgeries and therapies for epilepsy treatment include:

  • Vagus nerve stimulation (VNS) is used when various anti-seizure medications have not controlled seizures. VNS involves the insertion of a pulse generator (stimulator) inside the body and connecting it to the left vagus nerve in the neck. The stimulator releases electrical pulses through the vagus nerve to help regulate abnormal electrical brain activity, causing seizures.
  • Responsive neurostimulation (RNS) for epilepsy does not require surgically removing brain tissue. Instead, an intracranial RNS device is implanted into the skull, and electrodes are placed on the brain to detect abnormal electrical brain activity. It was developed to detect and prevent seizures before they happen, like an indwelling EEG that can detect and stimulate brain rhythms that might convert into seizures.
  • Deep brain stimulation. The surgeon uses an MRI to guide the permanent implantation of a device deep inside the brain. This device releases electrical impulses designed to disrupt abnormal activity, causing the seizures. The generator that sends electrical signals to this device is inserted inside the chest.
  • Respective surgery is the most common surgery for epilepsy. The surgeon removes a small section of the brain. The section removed is usually the site of the tumor, brain injury, or malformation. Most surgeries of this type are done on one of the temporal lobes—the area of the brain that controls vision, memory, speech, comprehension, and emotions.
  • Laser interstitial thermal therapy (LITT) is considered less invasive. The surgeon uses an MRI to guide and locate the area of brain tissue causing the seizures. The surgeon uses a laser to remove this area if the areas is small and limited in scope.
  • Corpus callosotomy. This surgery is usually performed on children whose abnormal brain activity spreads from one side of the brain to the other. The surgery involves either partial or complete removal of the part of the brain connecting the nerves on the right and left sides of the brain, called the corpus callosum. This type of surgery can help prevent falls and injury in patients with more violent motor features.
  • Hemispherectomy is an option for those children with broad areas of seizure onset that occur in utero or in early development as an infant
  • Functional hemispherectomy is used primarily in children;  The procedure disconnects sections of the brain that might contribute to seizure production. Sections of the brain are not removed but rather disconnected from forming seizures.

FAQs

FAQs

The latest information on epilepsy estimates that approximately 3.4 million people have epilepsy in our country—3 million adults and 470,000 children. According to these estimates, children between up to 17 years old represent 0.6% of those with active epilepsy.

Each state determines its own eligibility requirements for people with certain medical conditions. With regards to epilepsy, most states require that a person be seizure free for a pre-determined amount of time and submit a doctor’s evaluation of their ability to drive.

Death from epilepsy is rare; however, it is the leading cause of death among people with uncontrolled epilepsy. A condition called Sudden Unexpected Death in Epilepsy (SUDEP) kills about 1 in 1,000 people each year who are affected by uncontrolled epilepsy.

Epilepsy is the most common brain disorder affecting children and adults in the United States. Approximately 5.1 million people in the U.S. have some history of epilepsy, including some 3.4 million people who have active epilepsy.

Get Care

Get Care

Understanding the symptoms and causes of epilepsy is the first step toward resolving seizure episodes. NewYork-Presbyterian specializes in epilepsy services for adults and children throughout the New York City metropolitan area and Westchester. Our conveniently located facilities make it easy for people to access premium healthcare and service your neurological needs.