New Hope for Hard-to-Treat Epilepsy: Beyond Medications

For many people living with epilepsy, medication is a powerful tool that helps control seizures and improve daily life. But approximately 30 percent of patients suffer from a condition known as medically refractory epilepsy — a form of epilepsy that isn’t helped by anti-seizure medications.

Fortunately, thanks to new research and advancing technologies, there are options beyond prescription drugs, says neurologist Pooja Patel, M.D., director of the Epilepsy Program and Epilepsy Monitoring Unit at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health.

“If the patient has epilepsy and has failed two anti-seizure medications, one after the other or in combination, then we need to consider alternatives to medication,” Dr. Patel says. A study published by researchers in 2000 showed that 47 percent of epilepsy patients became seizure-free on their first drug, 13 percent on their second drug but only 4 percent on their third drug or a combination of two drugs. The remainder found very little relief through medications.

Epilepsy Can Develop at Any Age

Epilepsy is a neurological disorder characterized by recurring unprovoked seizures caused by abnormal electrical activity in the brain. Approximately 3.4 million Americans are living with epilepsy, which can develop at any age, according to the Epilepsy Foundation.

“Of course, we need to begin with a thorough evaluation and take into account the types of seizures the patient is having and how disabling they are before we move to other treatments,” Dr. Patel says. The evaluation may include the patient’s history, an EEG, MRI seizure protocol, functional neuroimaging, neuropsychological testing and intracranial EEG monitoring.

Sharing Advances in Epilepsy Treatment

Dr. Patel shared her expertise recently at the Marcus Neuroscience Institute’s Brain & Spine Symposium, an educational meeting to bring the latest advances to physicians and other healthcare providers.

Among the treatments for medically refractory epilepsy that she discussed at the symposium were:

Brain surgery — Intended to disrupt the neural network creating seizures, surgical options include temporal lobectomy, extra temporal resection, hemispherectomy, corpus callosotomy and hypothalamic hamartoma resection. Minimally invasive surgery is a great option in certain cases, as well.

Neurostimulation — Less invasive than surgery, therapies such as vagus nerve stimulation (VNS), responsive neurostimulation system (RNS) and deep brain stimulation (DBS), employ neurostimulators or devices that can help reduce seizure frequency and intensity. “These involve implanting a small generator in the chest or the skull,” she says. “All three devices can provide seizure reduction and reduce the intensity of seizures, and long-term data shows the results are lasting.”

Dietary therapies — Used for years as a treatment for those who are not candidates for surgery or do not want to undergo neurostimulation, dietary therapy can change how the brain gets its energy and help to stabilize electrical activity. “Multiple studies show that dietary therapies are effective for 50 percent or higher seizure reduction in the short term, compared with care as usual,” Dr. Patel says. A ketogenic diet, high in fats and extremely low in carbs, and a modified Atkins diet are most effective.

Physician-scientists at Baptist Health and around the world are working to find new answers for people with difficult-to-treat epilepsy, studying focused ultrasound, gene therapy and cell therapy. “Our treatment goal is seizure freedom, but it is also good quality of life,” Dr. Patel says. “Today we have many more options for our patients, even compared to just a decade ago.”

Baptist Health offers two nationally accredited epilepsy clinics — a Level 4 Epilepsy Center at Miami Neuroscience Institute in Miami-Dade County and a Level 3 Epilepsy Center at Marcus Neuroscience Institute in Palm Beach County. Both locations feature Epilepsy Monitoring Units.

Pooja Patel, M.D., neurologist and director of the Epilepsy Program and Epilepsy Monitoring Unit at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health