GENERAL EPILEPSY INFORMATION
Treatment of epilepsy
How do we treat epilepsy?
Your doctor may recommend medications as the first line option to prevent seizures from occurring. This depends on how old you are, and other features which will make your likelihood of seizures more
For example, some patients with benign Rolandic epilepsy don’t need to take medications. Some patients have a condition called juvenile myoclonic epilepsy and need to be on medications for a long time.
Medications reduce the chance of having a seizure by different mechanisms. If one medication does not work, or if the side effects are too bothersome, your doctor may chance medication or combine them (polytherapy).
In about one third of patient’s medications don’t work and those patients are considered refractory or resistant. In these situations, doctors like Dr. Bercovici who are epilepsy specialists will consider other options. In some patients with focal epilepsy we can do a surgical workup to see if epilepsy surgery can help reduce or eliminate seizures. For example, a lot of recent research has shown that patients who have ongoing seizures due to mesial temporal lobe sclerosis (hippocampal sclerosis; scar tissue) can do really well with surgery. About 60-70% patients can be seizure free if they are good candidates.
There are many patients who are not surgical candidates because the seizures are coming from multiple areas of the brain or those who have generalized epilepsy (see link). In those cases, we have other options:
Neuromodulation is a surgically implanted device for patients who may not benefit from traditional surgery whereby one part of the brain may be resected. This is pacemaker like device (see this example) which is inserted in the upper chest area and the wire on the inside of the neck. This is not brain surgery. The mechanism is not entirely known but it has been shown to reduce seizures by more than 50% in about 2/3 of patients who respond. A small percent of patients have become seizure free and interestingly this method has been shown to improve over time.
If you are patient of Dr. Bercovici he may discuss this option with you. While the surgery can be done at other locations, he will be able to do the necessary adjustments in his office
Image Source: epilepsyu.com
When people think of ketogenic diet they may be thinking of just bacon and eggs. This is a diet therapy which has been around for almost 100 years. It was one of first treatments of epilepsy in the 20th century but became less popular once medications became easier alternatives.
Ketogenic diet regained popularity when the directory Jim Abrahm tried to find a way to help control his son’s epilepsy. Charlie who had medically refractory epilepsy could not be controlled by medication and surgery was not an option. Jim went back to the original studies and found John Hopkins hospital who was still doing this therapy. Using the ketogenic diet, they were able to control his seizures and eventually wean him off medications. In honor of this, he directed a movie called First Do No Harm, and created The Charlie Foundation.
The studies have slowly been coming in support of ketogenic diet for medically refractory epilepsy and while we are fortunate for Charlie and his success seizure freedom is not always a possibility. We have seen some really good success with both pediatrics and adults who are treated on the ketogenic diet.
To learn more about the ketogenic diet and to get recipes and other resources, visit our resource page on ketogenic diet.
To learn more about information please follow these links or download educational pamphlets and guides.
Epilepsy: An Overview
Living With Epilepsy
A Guide for Parents
Activity Book for Children
A Guide for Caregivers
Epilepsy: A Guide for Teachers
Seizures and First Aid
Teens and Epilepsy
Seniors and Epilepsy
BECOME A PATIENT
SOUTHERN ONTARIO EPILEPSY CLINIC
SHERWAY MEDICAL CLINIC
102-190 SHERWAY DRIVE
TORONTO, ONTARIO, M9C 5N2
TORONTO WESTERN HOSPITAL
NEUROLOGY CLINICS, 5 WEST WING
399 BATHURST ST.
TORONTO, ONTARIO, M5T 1S8