After discussing your medical history and diagnostic tests, your doctor will start you on a treatment plan. Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with medication and surgical techniques.

Medication

The goal of treating epilepsy is to enable people to lead full and unrestricted lives with no seizures and no side effects. Antiepileptic drugs (anticonvulsants) are used to help control seizures. Typically, a gradual increase of dosage in medication will be prescribed, but it varies with each patient. Some antiepileptic drugs can interfere with the effectiveness of oral contraceptives.

Surgery

The most effective surgery for epilepsy involves the removal of the abnormal area, or the epileptic focus. People with certain forms of epilepsy can be seizure-free after such a procedure. Sometimes, recording electrodes are surgically implanted over the surface and into the brain to help identify the exact location where seizures arise. Once the electrodes determine the precise location of abnormal brain tissue, it is then removed during a second surgery (usually when the electrodes are also being removed). Typically, this is all accomplished during the same hospital stay.

Another type of surgery, palliative surgery, can reduce seizures when there is no identifiable area that causes the seizures, or if there is more than one focus. Palliative surgery can be in the form of brain surgery or vagus nerve stimulation (VNS). Palliative brain surgery disconnects areas of the brain that cause the spread of seizures, resulting in shorter, fewer and less severe seizures.

Vagus Nerve Stimulation does not require brain surgery.  The vagus nerve stimulator consists of a wire connected to a battery. About the size of a silver dollar or smaller, the battery sends a small electrical current to the wire, which is wrapped around a nerve in the neck called the vagus nerve. Stimulating the nerve sends impulses to the brain that reduce the likelihood of seizures. The strength and frequency of the stimulating current is determined with an external “programming wand” in the doctor’s office. This is adjusted over several office visits by your doctor to optimize the stimulation while reducing side effects such as a tickling feeling in the neck. In addition, patients and their caretakers can trigger the stimulator by waving a supplied magnet over the battery. For patients with epilepsy who have auras or seizures that don’t cause loss of awareness, employing the magnet can stop or shorten the seizure.

Most patients experience seizure improvement and approximately half experience more than a 50 % reduction in seizures. Patients often reduce medication, particularly those that produce unwanted side effects, and many also experience improved mood and behavior.

The procedure involves two incisions, one in the neck and one in the chest or armpit. The entire procedure takes one to two hours under general anesthesia. Typically, the patient comes to the hospital on the morning of the surgery and goes home that evening after recovery. There is usually a mild soreness after the procedure, but patients generally return to typical activities within a few days. After one or two weeks, the device is usually turned on in the doctor’s office.

Ashesh Mehta, MD, PhD, joined the North Shore-LIJ Health System in 2006 and is the director of epilepsy surgery at the Comprehensive Epilepsy Center located at LIJ Medical Center. Dr. Mehta's work has been dedicated to the surgical treatment of seizures.