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How epilepsy is treated when medications fail or surgery cannot be performed

Epilepsy is a neurological disorder characterized by repeated seizures, which cause sudden changes in one’s behavior due to temporary changes in the electrical functioning of the brain. In normal patients, small electrical impulses are generated in an orderly pattern inside the brain. Electrical impulses travel through neurons inside the brain and throughout the body via chemical messengers called neurotransmitters.

However, in a patient with epilepsy, the brain’s electrical rhythms often become imbalanced, resulting in frequent seizures. When a seizure occurs, according to the American Association of Neurological Surgeons, sudden and synchronized bursts of electrical energy disrupt normal electrical patterns, affecting a person’s consciousness, movement or sensations.

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When a person has at least two seizures that are not caused by a known medical condition, they are diagnosed with epilepsy.

According to the Epilepsy Foundation, approximately 50 million people worldwide suffer from epilepsy.

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Epilepsy can be treated with the help of antiepileptic drugs (AEDs), diet therapy and surgery. Most patients with multiple seizures choose medications as the initial treatment option.

There are some patients who have only one seizure, and the tests they undergo do not indicate a high probability of recurrence of seizures. Such patients do not need any medicine.

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Medicines do not cure the underlying condition of epilepsy, but only treat the symptoms. About 70 percent of epilepsy patients have positive results after taking medications, which work by reducing the tendency of brain cells to send excessive and confused electrical signals.

Some patients receive diet therapy that includes the ketogenic diet and the modified Atkins diet. The ketogenic diet includes foods high in fat, adequate protein, and low carbohydrates, while the modified Atkins diet is similar to the ketogenic diet, but less restrictive. The ketogenic diet is given in the hospital for three to four days, while the modified Atkins diet can be started as an outpatient.

“Dietary treatments such as the ketogenic diet may be considered. There are examples where this high-fat, low-carb diet has proven effective.” CyberKnife, Dr Aditya Gupta, Director, Artemis Hospital, Gurugram told ABP Live.

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How epilepsy is treated when medications fail, and when surgery cannot be performed

Medicines and diet therapy do not work in about 30 percent of epilepsy patients. They are considered clinically resistant.

For patients with medically resistant epilepsy, surgery is the best option to completely control seizures. However, if the epileptic area is a part of the brain that, if removed, could cause major neurological complications, surgery may not be possible.

If antiepileptic medications don’t control one’s seizures, and brain surgery is not possible because the epileptic area is located near sensitive areas in the brain, procedures such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS) may help. Can. National Health Service (NHS).

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What is vagus nerve stimulation?

VNS is a technique in which a small electrical device, such as a pacemaker, is placed under the patient’s test skin, and connected to a wire that goes under the skin and connects to a nerve in the neck called the vagus nerve. . When abnormal activity occurs in the brain, bursts of electricity are sent through wires to the nerve.

According to the NHS, it can help control seizures by changing the brain’s electrical signals.

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VNS is effective because the device emits controlled impulses to the vagus nerve to reduce seizures.

“VNS involves implanting a device in the chest that emits controlled impulses into the vagus nerve, effectively reducing seizures.” Dr. Sonia Lal Gupta, senior neurologist and director of Metro Group of Hospitals, told ABP Live.

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While VNS usually does not stop seizures completely, it can help make them less severe and less frequent.

However, VNS has some side effects such as hoarse voice, cough and dilated throat when the device is activated.

The battery of a VNS device lasts for 10 years, after which a new process will be used to replace it.

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What is deep brain stimulation?

While DBS is similar to VNS, the device placed in the chest is connected to wires that run directly into the brain instead of being connected to the vagus nerve.

When abnormal activity in the brain causes electrical bursts to be sent through wires to the brain, the wires alter the electrical signals, helping to prevent seizures. Electrodes are implanted in certain areas of the brain.

“In the case of DBS, electrodes are implanted to modulate specific brain areas associated with seizures.” Dr. Lal Gupta said.

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DBS is a new technology, and is not commonly used.

Some serious risk factors associated with DBS include bleeding in the brain, memory problems, and depression.

“When epilepsy is close to sensitive brain areas and does not respond to medication or surgery, other treatments such as vagus nerve stimulation (VNS) or reactive neurostimulation (RNS) may be explored. While RNS monitors brain activity and delivers targeted electrical stimulation to prevent seizures, VNS involves implanting a device to stimulate the vagus nerve. These strategies attempt to control epilepsy when more traditional techniques are impractical because they can damage critical brain areas.” Dr. Gupta said.

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What is Responsive Neurostimulation?

Responsive neurostimulation (RNS) is another technique used to control seizures when medications do not work. As part of the RNS technique, a neurotransmitter is placed under the skull and within the skull, and connected to two electrodes placed on the surface of the brain, either in the brain or a combination of both, according to the University of Pittsburgh. ,

Neurotransmitters constantly monitor brain activity and can detect seizures. This device helps prevent, reduce, or stop seizures by delivering small amounts of electrical current to the brain when seizure-like activity is detected.

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Research is being conducted to develop gene therapy and advanced neurostimulation techniques that may help control seizures in patients unresponsive to conventional therapy. According to Dr. Gupta.

For people dealing with difficult epilepsy, individualized techniques tailored to their needs may prove helpful.

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