Treatment

• Medical Treatment - Epilepsy is often managed with an anticonvulsant medication. Periodic blood testing monitors both the drug’s impact and safety. If you are prescribed an anticonvulsant drug, be sure to tell your epileptologist about all of the medications you are taking to avoid dangerous drug interactions. 
  
  
• Ketogenic Diet – This diet is high in fat and low in proteins and carbohydrates, and has an anticonvulsant effect in some epilepsy patients. To initiate the diet, the patient needs to be hospitalized for a few days.
  
  
• Vagus Nerve Stimulator - The vagus nerve stimulator is a device that, in some patients, may reduce the number and severity of seizures. It requires surgical implantation: one piece of the device is a wire which is wrapped around the vagus nerve in the neck, and the other piece, resembling a pacemaker, is implanted under the skin beneath the collar bone. The device is programmed to "fire" an electrical impulse on a regular basis, or is activated “on demand" with a magnet.
  
  
• Epilepsy Surgery/Pre-surgical Evaluation
  
  
  • Video Electroencephalogram (EEG) Monitoring - During a pre-surgical evaluation, the patient is admitted to the hospital for non-invasive digital video-EEG monitoring to determine the area of the brain in which the seizures originate. Anticonvulsant medications are discontinued for the duration of the monitoring so that several seizures can be recorded with simultaneous video image. Once the monitoring is complete, the patient resumes medication and can be discharged from the hospital.  Data is reviewed by the patient’s team of physicians, and discussed with the referring physician, the patient and family members. If more than one area of the brain is generating the seizures, the patient cannot have surgery.
    
    
  • Magnetic Resonance Imaging (MRI) - This study detects structural defects in the brain where the seizures may arise.
    
    
  • Magnetic Resonance (MR) Spectroscopy - MR spectroscopy studies the brain to determine the presence of biochemical markers which may indicate where seizures arise in the brain. NAA (N-Acetyl Aspartate) reflects the integrity of the brain cells. Creatine and choline reveal the degree of scarring caused by seizures. Decreased levels of NAA and increased levels of creatine and choline can help pinpoint the seizure source.
    
    
  • Positron Emission Tomography (PET) scan - PET scans visualize the metabolic activity in the brain.  Radioisotope is given to the patient through an IV.  The PET scan detects the concentration of the radioisotope throughout the brain. Areas of the brain that are less metabolically active due to seizure activity will contain lower concentrations of the radioisotope.
    
    
  • Single Photon Emission Computed Tomography (SPECT) Scan - This test examines blood flow in the brain during a seizure to help determine where a seizure originates in the brain.  During a seizure, blood flow markedly increases at the seizure source.  A SPECT scan can also be used to obtain baseline data with which the seizure data can be compared. 
    
    
  • Neuropsychological Testing - This group of tests evaluates thinking, memory, language and other mental abilities, and is usually performed both before surgery and six to 12-months after surgery.  The tests require several four hour sessions with a neuropsychologist trained in epilepsy treatment.  Results are compared with data from other studies to clarify how the patient’s cognitive profile relates to seizure activity.
    
    
  • Wada Test - This test is performed in conjunction with an angiogram to determine which side of the brain is dominant for language and memory, thereby helping to prevent language and memory loss after surgery.  Amobarbital is injected through a catheter in the carotid artery to anesthetize the cerebral hemisphere while the physician tests memory and language skills. One hour later, the same procedure is performed on the brain’s other hemisphere. Resulting data is analyzed by the patient’s medical team.
  
  
  • Psychological Support - Epilepsy, like most long-term or chronic disorders, can expose the patient to emotional distress, including personal and social difficulties, and adjustment issues.  Psychological treatment of depression and anxiety can help patients cope with stress and provide a supportive environment to aid the patient’s recovery and adjustment. Patients who undergo pre-surgical evaluations may also find psychological interventions helpful.