For about 50-70% of epilepsy patients, medication can be used to help control their epilepsy symptoms and manage their seizures. However, about 25-30% of epilepsy patients have what is called drug-resistant epilepsy. This means that medication doesn’t help with their seizures. While alternatives to epilepsy medication (like surgery) have previously been available, experts are excited to highlight other options that can help patients manage their seizures.
Diagnosing Drug-Resistant Epilepsy
According to Omar A. Danoun, M.D., an epilepsy neurologist at Henry Ford Health, because prescribing medication is often the go-to treatment for treating epilepsy, diagnosing patients with drug-resistant epilepsy is not something that doctors take lightly.
“For a patient’s epilepsy to be considered drug-resistant, there are certain criteria that need to be met before other treatment options would be explored,” says Dr. Danoun. “This means you would have to have failed to use two different antiseizure medications were that appropriately chosen for your epilepsy type, well tolerated and used for an appropriate amount of time before considering your case drug resistant.”
Treatment Options For Epilepsy
Because epilepsy is different from person to person (depending on your symptoms and what part of your brain is impacted by your seizures), epilepsy treatment is highly individualized. For all treatment options, your doctor will discuss the risks and benefits of each to determine the right choice for you.
Brain surgery
Brain surgery is an umbrella term for the many different procedures that doctors may use to help treat your epilepsy. All patients that are diagnosed with drug-resistant epilepsy are referred for surgery to determine if they are a good candidate. The best candidates are cases where doctors know exactly where in your brain the seizures start.
“Doctors may use the help of magnetoencephalography (MEG) scans to locate where they need to operate,” says Dr. Danoun. “These scans detect magnetic fields in the brain to map out where different brain functions take place.” From there, doctors are able to determine the best approach for you (i.e., which area they should treat, if any abnormalities are causing your seizures, etc.). Surgical options for epilepsy have a 50-80% success rate.
Laser ablation
Laser ablation is a type of minimally invasive surgery where a small laser wire is used to perform epilepsy surgery. These procedures are best used when only a small part of the brain is impacted by epilepsy, though location and size of the affected area can be the difference between traditional epilepsy surgery and minimally invasive options.
Nerve stimulation devices
These devices work by engaging different parts of the brain to reduce your seizure risk by up to 50%. Options include:
- Vagus nerve stimulation: An electrical device is implanted into the neck and connects the brain to the vagus nerve, a large nerve system of the body that connects the brain to the heart, lungs and digestive system. Electrical signals are sent to the brain to reduce your seizures.
- Deep brain stimulation: This device is implanted into the chest and has wires that connect to both sides of the brain, creating electrical signals to prevent seizure. This option is best for patients with front lobe or temporal lobe epilepsy.
- Responsive neurostimulation: Wires are connected into the side of the brain that causes seizures. When activated, it allows experts to study the brain and teach the device what a seizure looks like so that it can respond by sending electrical waves to the brain to stop the seizure at onset.
Ketogenic diet
The ketogenic diet prioritizes a high fat, low carbohydrate food intake. While you may have heard of the keto diet in the world of fad-dieting, there actually is a huge benefit in eating keto when you have epilepsy. “Historically, we’ve noticed that people who practiced intermittent fasting were able to manage their epilepsy better,” says Dr. Danoun. “The ketogenic dietic mimics those fasting states by creating ketosis – when the body doesn’t have enough carbohydrates for energy, so it uses stored fats instead - and in turn, prevents seizures.”
Make sure you work with a dietitian to perfect this diet as a form of epilepsy treatment. “While patients can see as much as a 40% success rate, remember this is a lifestyle choice to treat your epilepsy, not a small dietary change,” says Dr. Danoun. “There can be no cheat days as it could increase your likelihood of having a seizure.”
Epilepsy Care At Henry Ford
The Future Of Alternative Epilepsy Treatments
There are other epilepsy treatment options being explored by researchers, though they are in very early stages of discovery. These options are exploring the use of neuroactive steroids, personal genetics and the disease modifications of epilepsy as possible treatment avenues.
Additionally, there are some new antiseizure medications available that your doctor may explore as a treatment option even if you have drug resistant epilepsy.
Epilepsy is a chronic condition that requires life-long management. Dr. Danoun stresses that you work with an epileptologist (someone who specializes in epilepsy) to help you explore your treatment options and manage your condition throughout your life.
Reviewed by Dr. Omar Danoun, a neurologist at Henry Ford Health. He sees patients at Henry Ford Hospital in Detroit and Henry Ford Medical Center in Taylor.
