Epilepsy Medication, Surgery & Treatments

The Comprehensive Epilepsy Care Center is the largest and most comprehensive program in Long Island for the evaluation, diagnosis, and medical and surgical treatments of epilepsy in children and adults. We integrate the expertise of our clinical staff of neurologists, neurosurgeons and neuropsychologists with the availability of cutting-edge technology to provide a variety of customized epilepsy treatments utilizing epilepsy medication and epilepsy surgery. Our goal is to make our patients seizure-free or to minimize the severity and frequency of seizures so that they enjoy improved quality of life.

Epilepsy Medication
There are many medications used for the treatment of epilepsy. Decisions about when epilepsy medication therapy should be started and stopped are made carefully. Medications are not without risk, and careful judgment is required in selecting the medications which are best suited for each individual patient.

Our knowledgeable staff of physicians and nurses will assist you in making the difficult decisions involved in epilepsy medication treatment. For over 10 years, Comprehensive Epilepsy Care Center has been an active center in the study and development of anti-epileptic medications and is continuously researching new medications and treatments for epilepsy.

There are different types of epilepsy and many different types of anti-epileptic medications, each person responds differently to a given drug. The choice is influenced by factors including potential side effects, seizure types, frequency and severity of seizures, age, sex, overall health and medical history. As each person’s circumstance is different, certain epilepsy medications may be more appropriate for some patients than others. There are also unique issues for pregnant women and women planning to become pregnant which may require the assistance of epilepsy specialists. You and your doctor can discuss which drugs will best treat your epilepsy.

Unacceptable side effects of epilepsy medications are seen in up to 5-10% of patients. A list of current antiepileptic medications with their most common indications and side effects is presented in the table below (see table). Side effects for all the listed medications may include: rash, nausea, upset stomach, lethargy, dizziness, diarrhea, blurred vision. Of course, as in most cases, you may not experience any side-effects, or they may be minor. Their severity will likely depend on the type of medication, dose and length of epilepsy treatment. Side-effects are typically worse at higher doses, but they may become less severe over time as your body adjusts to your new medication. Always consult with your physician if you are experiencing any bad reactions to your medication.

It is also important to note that you may have to try more than one drug, or a combination of drugs before finding the right combination for you. Combining drugs can be complicated, because some epilepsy medications can interact with others to increase the possibility of unwanted side-effects. Our caring and knowledgeable staff at Comprehensive Epilepsy Care Center will assist you in choosing a personalized medication program that will give you the greatest benefit and the least side-effects.

Epilepsy Surgery
If anticonvulsant medications do not adequately control your seizures, or you are experiencing unacceptable side effects from the medications, you are not alone. One-third of patients with epilepsy experience the same problems. Fortunately, epilepsy surgery can help improve seizure control and even make seizure-freedom a possibility. In the past, patients usually tried several medications with poor results for many years before being considered for surgery. Now, surgery is considered sooner because of studies that show that the earlier surgery is performed, the better the outcome. A person who has been given several seizure medicines in adequate dosages and for a long enough period without a good response is unlikely to achieve complete seizure control with another kind of medicine. The decision of whether you are a candidate for surgery and the exact nature of the surgery is based upon a number of diagnostic tests.

Why Should I Consider Epilepsy Surgery?
The main reason to consider epilepsy surgery is to reduce the harmful effect of epilepsy seizures. Some of these may include:

• Broken bones or other injuries from falling during a seizure
• Brain damage from prolonged seizures
• Sudden death from epilepsy, which has up to a 1% risk per year in patients who have uncontrolled seizures
• Anxiety over not knowing when the next seizure will happen

Types of Epilepsy Surgery
Epilepsy surgeries differ with respect to their goals and amount of invasiveness. The most effective type of epilepsy surgery and the one that is most likely to result in seizure-freedom is called resective epilepsy surgery. It involves the removal of an epilepsy-causing area of the brain. Sometimes, surgery is aimed at finding the source of seizures and mapping of brain function. Other forms of epilepsy surgery aim to reduce seizures and may involve interruption of brain pathways, brain stimulation or nerve stimulation. State-of-the-art technology is applied to perform the safest and least-invasive procedure that will help the patient to achieve the highest possible quality of life.

Resective Epilepsy Surgery
During this surgical procedure, the seizure-producing area of the brain is removed while taking care to avoid harm to brain areas that are important for movement, vision, memory, language and sensation. This surgery is performed under general anesthesia with a combination of neuronavigation, functional brain mapping and intraoperative electroencephalography. Microneurosurgery is often required. This is the most effective form of epilepsy surgery and should be done if seizure elimination is the goal. Unfortunately, not every patient is a candidate for resective epilepsy surgery.

Diagnostic Epilepsy Surgery
This type of surgery involves implanting electrodes into or near brain areas that are involved in a patient’s seizures in order to pinpoint where seizures begin and where brain areas that carry important brain functions are located. This is required only when noninvasive studies cannot precisely pinpoint these areas. Typically, this procedure is performed under general anesthesia. The patient stays in the hospital for one-to-two weeks until a second surgery is performed to remove the electrodes. This type of surgery is performed in patients who have a good chance of being resective epilepsy surgery candidates.

Corpus Callosotomy
This is a procedure that is performed to disconnect the two sides of the brain in patients who have severe and frequent seizures that result in falls and injury, but are not candidates for resective epilepsy surgery.

Vagus Nerve Stimulation
This type of epilepsy surgery does not involve brain surgery at all. Instead, a wire is placed around a nerve in the neck which transmits signals to the brain to reduce seizures. There is very little risk associated with this operation. Patients typically go home on the same day after this one-to-two-hour outpatient procedure. While the risks of this procedure are low and seizures are frequently reduced, it is rare that a patient will be seizure-free after this procedure.

Brain Stimulation
Various forms of brain stimulation have been shown to reduce seizures in clinical trials. Approval of these procedures by the Federal Drug Administration and by the Centers of Medicare and Medicaid are still pending. Consideration of the target of the stimulation and whether an approved type of epilepsy surgery might be effective are important issues to consider.

Advances in Epilepsy Surgery
Surgery for epilepsy has been performed for over a century, but over the last few years, improvements in technology have made it safer and more effective than ever. Surgeons who specialize in epilepsy surgery use state-of-the-art technology for imaging, intraoperative navigation and microneurosurgery to make epilepsy surgery the treatment of choice for many patients with medication-resistant epilepsy. The least invasive approach is chosen to maximize benefits and minimize risks.

Success of Epilepsy Surgery
The success of epilepsy surgery is usually measured by improvement in seizure control and in quality of life. Each patient is unique, and a successful epilepsy surgery treatment plan involves a careful review of the difficulties that the patient is experiencing as a consequence of epilepsy and a formulation of their treatment goals. Ninety percent of patients who have undergone brain surgery for epilepsy at Cushing Neuroscience Institute's Comprehensive Epilepsy Care Center at North Shore-LIJ are either seizure-free or have significantly improved seizure control. Significant improvements in lifestyle also occur, with patients more likely to be going to school, maintaining employment or even driving a car after successful epilepsy surgery. For some patients, anticonvulsant epilepsy medications may be reduced or discontinued.

 

Make an appointment at our Comprehensive Epilepsy Care Center
Cushing Neuroscience Institute’s Comprehensive Epilepsy Care Center makes it easy for you to take the first steps in ensuring the best neurological care for yourself or your family. Simply email us at neuro@nshs.edu, call us at (516) 325-7060 or fill out our Request an Appointment form.