Diagnostic and Treatment Options for Epilepsy
Nonsurgical And Surgical Options For Epilepsy
The Miami Neuroscience Center in South Miami offers a full spectrum of diagnostic and treatment options for those suffering from recurring seizures. The complexity of epilepsy and seizures is vast and many clinical factors go into achieving a proper diagnosis and establishing an optimal treatment plan. Seizures can be mild and unnoticeable such as blankly staring into the distance or cause violent convulsions that may result in injury and in some cases death.
Our epilepsy team is comprised of Neurologists, Epileptologists (neurologist specializing in epilepsy and seizures), Neurosurgeons, and EEG (electroencephalogram) technicians.
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Seizures are emotionally, socially, and economically burdensome on those that suffer from them and their loved ones. Our Epilepsy Team is adept in the challenges faced everyday for those suffering from epilepsy. Improperly treated and uncontrolled, seizures can pose significant health risks for epileptics, burden caregivers, hinder activities daily living, lead to feelings of embarrassment, fear, and confusion, and cause cognitive, behavioral, and motor dysfunction.
Explore All Our Treatment Options
We seek to improve the quality of life of all our patients by utilizing the latest treatments and technologies to help them take control of their seizures. After establishing a proper diagnosis we begin with non-surgical options such as medication and lifestyle changes. If non-surgical options haven’t worked for you our neurosurgeons have over 35 years of experience providing a variety of surgical treatments for epilepsy including stereotactic radiosurgery and craniotomies.Schedule a Consultation
At the Miami Neuroscience Center, our doctors use several tests to diagnose epilepsy. Diagnostic testing is important and enables our doctor to decide on the right treatment plan for your type of epilepsy. These include:
To test the functions of your brain and nervous system.
To check for infection, hormone levels, or to rule out other causes of seizures such as diabetes, electrolyte imbalances, anemia, and hypoglycemia (low blood sugar). Some blood tests include: CBC (Complete Blood Count) and Chemistry Panels (such as electrolyte panel and comprehensive metabolic panel). These tests can also help in prescribing an appropriate seizure medication if you suffer from kidney, liver, or other metabolic issues.
To look for abnormal brain activity. This is a noninvasive diagnostic procedure that uses small metal discs placed around your brain to detect electrical signals “brain waves”. The electrodes are placed on different areas of your brain or lobes and record the waves (or EEG traces) either on a piece of paper or electronically. A physician analyzes these traces to determine which areas of the brain are abnormal or the (focus) source of the seizure. Epileptic spikes are those that surpass the normal frequency waves or oscillations. If the EEG reading does not provide adequate information, you may need an EEG reading during an active seizure (known as the ictal phase). Epilepsy Monitoring Units (EMU) in hospitals have the capabilities to safely analyze and control seizures during these ictal recordings. Another test that can provide a more detailed brain reading is called a electrocorticography, however, this test is more invasive and requires the implantation of the electrodes through the skull and within the dura mater of the meninges.
MRI or CT scan
To locate the source of epilepsy. Our physicians may look for tissue scarring, tumors, or obstruction that may be causing epilepsy. For example, scarring of the hippocampus (also called hippocampal sclerosis) is indicative of mesial temporal lobe epilepsy.
Treatment of epilepsy will depend on the type of epilepsy and the frequency of seizures. There are a variety of non-surgical and surgical treatment options for epilepsy depending on your specific condition. Our aim at the Miami Neuroscience Center is to strive for complete seizure control or the best possible seizure control for your seizures.
Called antiepileptic drugs (AEDs), seizure medications, or anticonvulsants: Medications are generally taken daily and can control seizures in 70% of cases. AEDs are classified into two broad categories: narrow-spectrum and broad-spectrum AEDs. Broad-spectrum AEDs are used in patients that suffer from different types of seizures or seizures within multiple areas of the brain while narrow-spectrum AEDs are used for specific seizures or seizures isolated to one part of the brain.
Some of the most common epilepsy medications include:
- Brivaracetam (Briviact): If taken orally this medication can be prescribed for adults and children over the age of four or if injected intravenously it can be used in people over the age of 16. It works by blocking the release of neurotransmitters in the brain that cause seizures. It can be used to treat partial onset seizures. Side effects may include:
- Dizziness or seeing double
- Nausea Anxiety and other emotional or behavioral changes
- Carbamazepine (Tegretol): This medication controls seizures by preventing electrical activity that causes seizures from spreading throughout the brain and restoring the normal activity of neurotransmitters. It is commonly used to treat tonic-clonic seizures and partial seizures. It is also used in the treatment of trigeminal neuralgia to help control neuropathic pain. Side effects may include:
- Dry mouth
- Nausea and vomiting
- Acetazolamide (Diamox): This medication works by inhibiting the production of the enzyme carbonic anhydrase, in order to help control seizures. It is usually used to treat absence, partial, and tonic-clonic seizures. Side effects may include:
- Loss of appetite
Other antiepileptic drugs (AEDs) include sodium valproate, lamotrigine, oxcarbazepine, ethosuximide, topiramate, levetiracetam, clobazam, and eslicarbazepine. To see a full list of AEDs and the seizure types they are used to treat click this link.
Cannabinoids such as cannabidiol (CBD) may help decrease the severity and frequency of seizures. Although well-defined controlled trials are sparse, some studies have shown promising results for refractory epilepsy, tonic seizures, atonic drop seizures, and seizures associated with Lennox-Gastaut syndrome and Dravet syndrome.
One study demonstrated a 41.9% reduction in the frequency of drop seizures using 20mg CBD oral solution each day for 14 weeks. Although further research is needed, the safety and efficacy of cannabinoids for epilepsy treatment can be illustrated by the FDAs approval of Epidiolex. This CBD oral solution is used to treat difficult to control seizures caused by Lennox-Gastaut syndrome and Dravet syndrome. 99% of Epidiolex is CBD extract. The low concentration of tetrahydrocannabinol (THC) means that patients will not experience the psychoactive and euphoric effects commonly associated with marijuana.
Cannabidiol activates different receptors in the brain such as CB1 and CB2. CB1 receptors moderate neurotransmissions and seizure activity by changing calcium and potassium channels in neuron synapses. Side effects of cannabinoids may include diarrhea, sleepiness, thirst, hunger, and elevated transaminase levels in the liver.
Cannabinoids may help manage epilepsy and decrease the dosage of AEDs required to control seizures contributing to a better lifestyle. Prior to coadministering cannabinoids and AEDs our physicians must first evaluate their pharmacological interactions. Some drugs may enhance anticonvulsant effects of CBD or CBDs use with certain medications may lead to liver injury.
Rescue treatments are distinct from daily seizure medication because they are only used “as needed” and in cases of emergency. Emergency situations that may require the use of rescue treatments include seizures that:
- Last longer than normal
- Last longer than 5 minutes (status epilepticus)
- Occur in an increasing frequency (seizure clusters)
- Cause abnormal symptoms than those typically experienced
Examples of rescue treatments include:
- Diazepam (Valium)
- Lorazepam (Ativan)
- Vagus Nerve Stimulators
Benzodiazepines (Benzos) are sedatives that can inhibit (or slow down) the central nervous system, stopping seizures. They can be prescribed in many forms such as a pill, nasal spray, liquid, and rectal gel. Benzos that can be used to treat seizures include clonazepam, diazepam, lorazepam, and midazolam.
You may be surprised to know that what you eat may be affecting your epilepsy. Making simple changes in your dietary habits can help you control seizures. Here are some simple changes that can help:
- Reduce simple sugar intake: Eliminating simple sugars which are found in foods such as white bread and potatoes. This will help you maintain a healthy glycemic index and can reduce the risk of seizures.
- Avoid processed foods: Eating healthy, whole foods rather than processed foods will not only help you keep to a low-glycemic diet, it will also help you maximize your nutrient intake.
- Avoid allergens: Avoiding allergens such as gluten, soy products, and dairy products can also help to control seizures, particularly in children.
Types of Epilepsy Surgery
If your epilepsy has not responded to medications or dietary changes, there are several types of surgery that may help to control your seizures. Surgical treatment options for epilepsy include ablation, resection, or neurostimulation in the area of the brain causing the seizures. When determining which surgical option is best for you our epilepsy specialists take the following into consideration:
- The non-dominant side of your brain (to limit functional damage)
- If you are suffering from focal or generalized epilepsy
- Surgical operability and difficulty to reach the problem area
- Your age and general health
- Abnormal imaging or tests (CAT, MRI, or EEG)
- Effectiveness of non-invasive treatments
- Personal needs, preferences, and lifestyle
- Your risk of injury or death (accidental or SUDEP) if left untreated
Also called Gamma Knife radiosurgery, this is a non-invasive treatment that is used to treat seizures which arise in a medial temporal lobe. This procedure involves specially designed equipment to target minute radiation beams at a focal region of the brain. In the case of temporal lobe epilepsy, the rays are targeted at the amygdala and hippocampus within the brain.
Radiosurgery involves no incisions and has minimal effect on the brain tissues through which it passes. It does, however, deliver a specifically targeted dose of radiation at the point where the beams converge. This makes it useful for targeting brain tumors or other abnormalities which cause seizures.
Studies have indicated that between 65% and 81% of patients treated with radiosurgery for temporal lobe seizures have become seizure free. Although some patients did not achieve seizure freedom, in one case study the median frequency of seizures declined from 6.16 times per month to .33 per month. These studies have small sample sizes so further research is needed to establish clearer data.
81% view case study | 65% view case study
Prior to the surgery, you will be given a light sedation so that our surgeon will be able to stimulate areas of your brain and assess your response. During the procedure, our surgeon will make an incision in your scalp and remove a small portion of your skull to enable him to access your brain. Once the designated area of the brain is removed, our surgeon will replace the fragment of skull and close the incision.
Risks associated with brain surgery for epilepsy may include:
- Memory problems
If you’re looking for surgical treatment for epilepsy in South Florida, we perform these and other brain surgeries for epilepsy:
Surgical Treatment Areas
This type of surgery removes the portion of the brain which is responsible for seizures and is the most common form of epilepsy surgery for people whose epilepsy arises in one focal area of the brain in a non-critical region.
Also called temporal lobectomy, the aim of this procedure is to reduce the number and severity of your seizures, or prevent them altogether. Up to 70% of sufferers no longer experience seizures following this type of surgery. Even in those that continue to have seizures, the frequency of the seizures is greatly reduced. During this procedure, our doctor will remove the region of the temporal lobe where seizures typically start.
Typically, you will stay in hospital for 3-4 days after brain surgery. You may feel mild discomfort and swelling at the site of the incision. This will resolve within several weeks. Your stitches can be removed within two weeks of your surgery. You may experience frequent headaches during the weeks following surgery but these will gradually dissipate.
You may not be able to resume school or work between one and three months following brain surgery. Our doctor will prescribe oral steroids after surgery to reduce swelling in the brain. After surgery you may continue to take your normal epilepsy medication, for up to two years, even though you are not experiencing seizures.
Living With Epilepsy
Everyone experiences epilepsy differently.
Management of seizures can vary widely from person to person and can range from almost total control to very little control. Living a healthy and independent life is an important goal, and there are many ways you can make life with epilepsy a little easier, such as:
- Joining a support group
- Wearing an epilepsy medical bracelet
- Contacting the Epilepsy Foundation for information
- Developing a seizure plan for family members and work colleagues
Preventing Epilepsy Seizures
You can help prevent epilepsy seizures in the following ways:
- Understanding and avoiding your triggers
- Maintaining a healthy sleep schedule
- Taking medications as prescribed
- Avoiding alcohol and drugs
- Avoiding visual over-stimulations such as flashing lights and video games
- Hormonal Disbalance
- Exercise and relaxation
Exercise for Epilepsy
Exercise has some important health benefits for people suffering from epilepsy. Only in rare cases can physical activity trigger epileptic seizures. Regular exercise can benefit epilepsy sufferers in the following ways:
- Reducing stress and anxiety
- Increasing the flow of oxygen to the brain
- Reducing the frequency of seizures
- Improving cardiovascular health