On the Frontline of Epilepsy Treatment
When Should Someone With Epilepsy Consider Surgery? continued...
One study came out in 2001 that showed that about 60% of people who had a temporal lobectomy (in which the temporal lobe located on the side of the brain is removed) had no seizures, or at most, a few auras afterward. In the other group, which got the best medication we have but didn't get surgery, only about 8% got the same results.
Surgery may also be good for people in early stages of the disease. There's a trial under way comparing surgery with standard medical care in people who developed temporal lobe epilepsy in the last two years. It's called ERSET (the Early Randomized Surgical Epilepsy Trial). We'll have to wait for the results.
What Role Do Implantable Devices Play in Epilepsy Treatment?
When epilepsy isn't being controlled by medication and surgery isn't an option, we turn to devices. There's one on the market now: the vagus nerve stimulator (VNS). In about a quarter of the patients who get it, there's a substantial reduction in the number of seizures. It's certainly a low-risk procedure.
How Does the Vagus Nerve Stimulator Work?
VNS therapy works by sending an electrical pulse to the vagus nerve in the neck. It's not clear how VNS therapy stops seizures, but it's believed that the device blocks certain brain impulses that direct the body to start a seizure.
The VNS device is powered by a small battery implanted in the chest. In some cases, it can make someone almost seizure-free. I've never personally seen someone who had no seizures with VNS, but others have reported that.
Then there are some other exciting stimulator research projects under way. There's one that adapts some of the brain stimulation therapy used for people with Parkinson's disease. We'll have to see what the results of the trial are.
The other stimulator trial that's going on is called NeuroPace, which I'm actually involved with. Most nerve stimulation is on a fixed program. You set the device to send out pulses of a certain duration at certain intervals and it goes around the clock. The NeuroPace is a different concept. It uses the technology from cardiac defibrillator devices to respond to electrical activity in your brain. Electrodes are placed where seizures are suspected of coming from, either on the surface of the brain or deep within it. This is hooked up to a miniature recording device that samples brain activity, like a tiny EEG machine. When it senses that the pattern is abnormal, it fires an electrical pulse to disrupt the pattern.
Again, this is very early in the course of testing, so we don't know if it's going to work well enough to be licensed. But I think that there's a great deal of excitement about all of this stimulation work. [Note: NeuroPace was awaiting FDA approval as of June 2012.]