Epilepsy is defined as having two or more unprovoked seizures. Seizures are sudden changes in the electrical activity of the brain. They cause changes in behavior, sensations, awareness and motor function. Epilepsy is now divided into four basic types: Generalized, Focal, Generalized and Focal, unknown if generalized or focal.
1% of the US population suffers from epilepsy: 3 million adults and 470,000 children.
It is the 2nd most common neurologic disorder affecting over 1 million patients in the US.
Anti-epileptic medications continue to be first line treatment for epilepsy. 2/3 of patients with epilepsy are well controlled with medications alone.
30% of patients are not well controlled with anti-epileptic medications. Despite the many new medications being introduced over the last 25 years this number has remained stable. Early consideration for surgical options is important when medications fail to provide seizure control.
Surgical treatment for epilepsy:
When focal epilepsy becomes refractory to medication management then surgical options should be considered early. Surgical options for medical refractory focal refractory epilepsy can provide a 50-80% chance of seizure freedom. Alternatively patient who have failed multiple medications have less than a 10% chance at good seizure control.
Localization is the key: For patients who have epilepsy that is not well controlled on medication localization is important to long term management. Multiple surgical options are available for treating epilepsy and the choice of procedure is often determined by the location of the seizures. Long term inpatient video EEG monitoring and Stereoelectroencephalography (sEEG) monitoring is available for targeting seizure origins. These services are available for both adults and children at Oishei Children’s Hospital of Buffalo.
RNS- Brain-responsive neurostimulation: This new technology records the electrical activity of the brain and can recognize the early brain activity seen in seizures. When a seizure is detected the RNS will stimulate the brain and suppress the seizure activity. Patients report a 75% reduction in seizure activity at 9 years (RNS website)
Anterior Temporal Lobectomy– Surgically the skull is opened and a portion of the Temporal lobe is removed. Although this is an invasive operation an anterior temporal lobectomy can provide a good chance to cure epilepsy.
Laser ablation– This minimally invasive surgery has less recovery and less pain. During surgery a laser probe is inserted through a small hole in the skull. The probe is advanced and guided using MRI to its target. In real-time the laser is utilized to remove the seizure focus without damage to the surrounding tissue.
VNS – Vagal Nerve Stimulation provides electrical impulses to the brain by utilizing the vagus nerve. These mild impulses are routinely delivered by an implantable device in the chest wall. Stimulation can additionally be triggered with the use of a magnet that the patient wears on the wrist. Vagal Nerve Stimulators decrease the overall number of seizures that patients experience and can prevent seizures from occurring.
DBS – Deep brain stimulation: Approved for the treatment of focal epilepsy that is not well controlled with medications when other surgical options are not appropriate. This therapy uses a surgically placed electrode in the brain to stop brain signals that cause seizures.
How do I become a patient: Contact Dr. Jonathan Riley at 716-218-1000 for epilepsy consultation.
Links to include: John R. Oishei Children’s Hospital https://www.ochbuffalo.org/care-treatment/epilepsy
Epilepsy Foundation https://www.epilepsy.com/
Surgical Locations: Sisters of Charity Hospital, Niagara Falls Memorial Medical Center, Millard Fillmore Suburban Hospital, Mercy Hospital of Buffalo, Buffalo General Medical Center, Gates Vascular Institute, Kenmore Mercy Hospital