Improving Epilepsy Care

Posted on 1 March 2021

Advances in neuromodulation procedures offer new hope for patients suffering from an often misunderstood condition.

Epilepsy is common, and affects one in 100 South Africans. It also has a long documented history; the condition has been recorded and treated since at least 2000 BC. Despite its prevalence, however, it remains a debilitating, dangerous and mis- or under-diagnosed disorder.

“Most people know you can hurt yourself during a seizure, whether it’s by biting your tongue or hitting your head, crashing while driving or drowning while swimming,” says Dr Nico Enslin, a neurosurgeon at Mediclinic Constantiaberg. “But it’s important to realise that while you have a seizure, your brain does not receive an adequate supply of oxygen – and over time, epileptic seizures can cause great damage to your brain.”


While many people living with epilepsy manage their seizures effectively through medication in the short term, seizures cause cognitive dysfunction over time, and many others develop resistance. “These challenges make surgery the preferred option, as it’s the only way to completely cure epilepsy,” says Dr Enslin. “But it is not without risks.”


A resection procedure, where the part of the brain that causes epilepsy is cut out completely, is often the first and best choice, he says. “Disconnection procedures – in which the part of the brain that causes epilepsy is not removed completely, but rather cut off from the rest of the brain – are another popular and effective option, especially when the part of the brain that causes epilepsy can’t be resected safely without causing more harm.”


These surgeries may cure a patient’s seizures but as they’re invasive and complex surgical techniques that involve opening the brain, they can cause bleeding and injury. “Plus, there are certain types of epilepsy where we can’t localise the origin of the seizures to a specific part of the brain,” Dr Enslin explains. “Certain syndromes have widespread epilepsy. In these cases, resective surgery is not possible.” Now, there is another option, he adds.


Neuromodulation techniques are an alternative treatment for patients who do not respond to medication. It can be performed while leaving the brain intact, effectively modulating seizures to a negligible level while reducing the risk of major surgery. “By applying specific electrical currents to particular parts of the brain, we can reduce the severity and frequency of seizures.”


Deep brain stimulation, vagal nerve stimulation and responsive neurostimulation (RNS) therapy are related but subtly separate procedures that alter nerve activity by delivering electrical or pharmaceutical agents directly to a targeted area of the brain.


“Deep brain stimulation works by inserting a thin electrode in a delicate and accurate way into a deep area of the thalamus – the central command station of the brain. The ‘battery’ then provides a light electrical current to the specific part of the brain that is shown to limit seizure activity,” Dr Enslin says. “Vagal nerve stimulation delivers a current to a small nerve in the neck that relays currents back to the thalamus and modulates the frequency and severity of seizures in the same way. And RNS therapy uses an implanted device to prevent seizures before they begin, in much the same way that a pacemaker detects and treats abnormal heart rhythms.”


Whereas open surgical procedures can require up to 10 days’ recovery time, neuromodulation patients go home two to three days after treatment – and straight back to a normal, better life. While the effects are immediate after therapy, they also improve over time, reducing the severity of seizures further with prolonged use.

Published in Magazine

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