On the Frontline of Epilepsy Treatment
Do You Think the Ketogenic Diet Is Helpful for Epilepsy?
It is a valuable tool in certain children with catastrophic epilepsy. About a quarter of the people who go on it get good control of the seizures. The problem is that the safety of the diet for long-term use is in question. It's a starvation diet. The brain is tricked into thinking that you're starving to death so that you wind up with decreased calorie intake. It makes the brain burn ketones instead of glucose (sugar from food) and your seizures are controlled. But it can slow down the growth of children. And you can't eat a high-fat diet for a long time. We already know the dangerous long-term consequences of eating a high-fat diet in adults.
So the ketogenic diet is a reasonable alternative to intractable epilepsy. But I'm reluctant to use it in adults. Besides, it's such an unpalatable diet that probably only young kids can stay on it, since they have no choice in what they eat because their parents make their meals.
What Do You Think About Focused Radiation Epilepsy Treatments, Like the Gamma Knife?
I actually think that that this approach is overhyped. I don't doubt that radiation can destroy the focus of a seizure. But the problem is that it can also damage the brain cells around it. Even though these radiation beams are focused, no matter how carefully you aim them, the radiation will still scatter. These beams are not like a laser. They're not as precise as surgery. And we're talking about brain surgery, where a few millimeters can make all the difference in the world.
So I think it should be considered in some cases, such as in people who have lesions that need to be removed but who aren't suitable for surgery. But I don't think that it's a good substitute for standard surgery.
What New Epilepsy Treatment Approaches Are on the Horizon?
A lot of people are working on the genetics of epilepsy now. We already know the genes that cause a few rare forms of epilepsy. But for most forms, we don't know which genes are involved. Once we learn how to locate these genes and understand what they do, imagine how we can improve therapy. We could develop blood tests to see what kind of epilepsy a person has. Most of the time, when a person walks in the office who has recently developed epilepsy, we don't understand why it happened. Studying the genetics of the disease could give us that information and allow us to be much more precise in our treatment.
What Else Should People With Epilepsy Know About Treatment?
The bottom line is that if you're still having seizures or side effects after treatment, then go see your doctor and try a new approach. If that doesn't work, see a specialist.