Mayo Clinic neurosurgeon describes the latest options for treating epilepsy

Newswise—ROCHESTER, Minnesota —epilepsyis a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of consciousness. Anyone can develop epilepsy, and epilepsy affects men and women of all races, ethnic backgrounds, and ages. In this expert warning Jamie Van Gompel, MDA neurosurgeon at Mayo Clinicdescribes the latest treatment options.

“The range of possible treatments is now much broader,” says Dr. Van Gompel. “We have really improved patient outcomes. I think it’s important to explore treatment options because they can have a significant, meaningful impact on patients’ lives.”

Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy can grow out of the condition as they get older.

Drugs for epilepsy have improved and remain the most common way to treat epilepsy: Treatment with drugs, or sometimes surgery, can control seizures in the majority of people with epilepsy, says Dr. Van Gompel.

Open surgery to remove the part of the brain that causes the seizures is still an important treatment option for epilepsy that isn’t controlled by medication. New treatment options for epilepsy have emerged in recent years, including minimally invasive options.

Recent treatments include:

• deep brain stimulation. This is the use of a device that is permanently placed deep in the brain. The device periodically emits timed electrical signals that interrupt the seizure-triggering activity. This procedure is guided by the MRI. The generator that sends the electrical impulse is implanted in the chest.
• Responsive neurostimulation.These implantable, pacemaker-like devices can help significantly reduce the frequency of seizures. These reactive stimulation devices analyze patterns of brain activity to detect when seizures begin and deliver an electrical charge or drug to stop the seizure before it causes disability. Research shows that this therapy has few side effects and can provide long-term seizure relief. This device is placed in the skull.
• Interstitial Laser Thermotherapy (LITT). This is less invasive than resective surgery. It uses a laser to locate and destroy a small section of brain tissue. An MRI is used to guide the laser.
• Minimally invasive surgery.New minimally invasive surgical techniques such as Techniques such as MRI-guided focused ultrasound, show promise in treating seizures with fewer risks than traditional open-brain surgery for epilepsy.

dr Van Gompel encourages people with epilepsy to check with their GP or neurologist about their current treatment and not hesitate to seek a second opinion at an epilepsy center, particularly if they are experiencing medication-related side effects or have persistent seizures.

“If you haven’t seen a specialist in the last five years, you should see an epileptologist at a specialized treatment center,” says Dr. Van Gompel. “Epilepsy treatments are changing so rapidly these days that there may be something new that can help.”

Research in this area continues to focus on seizure prevention; Prediction, also known as seizure prediction; and treatment. dr Van Gompel predicts that the use of artificial intelligence and machine learning will help neurologists and neurosurgeons continue to improve treatment options and outcomes.

“I think we’re going to move more and more towards removing less and less brain tissue,” says Dr. Van Gompel. “I believe that in the coming decades we will understand brain stimulation to such an extent that we may never again remove brain tissue. Maybe we can treat this misbehaving brain with electricity or something else. Maybe sometimes it’s a drug delivery, right into the area, that rehabilitates that area to make it functional again. That is our hope.”

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