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Controlling Epileptic Seizures

Finding solutions beyond medication

While medications help control seizures in many people with epilepsy, approximately 40 to 50 percent find no relief from drugs.

“At one point, we thought medications would be the whole solution to epilepsy, but we now know that’s not the case,” says Michael Smith, MD, director of the Rush Epilepsy Center. “Medications are just part of the equation.”

Developing options for hard-to-treat seizures

For some individuals, surgery may be an option, but for others, the risks of surgery far outweigh the benefits. If seizures arise from multiple areas of the brain or from especially crucial areas, like the parts of the brain that control speech and movement, surgery could seriously impair the patient. 

To help this hard-to-treat population of epilepsy patients, investigators at Rush evaluate new avenues of treatment.

In fact, Rush was the first in Chicago to offer epilepsy patients the vagal nerve stimulator — which prevents seizures by sending mild pulses of electrical energy to the brain by way of the vagus nerve.

Another neurostimulator device investigated at Rush, the RNS System (which was developed by a company called NeuroPace, and is therefore often called the NeuroPace device), is currently being reviewed by the Food and Drug Administration (FDA).

Smith — who participated in the RNS System’s clinical trials — is hopeful that it will soon be approved for use in select patients with refractory (or resistant to treatment) seizures and will be another valuable treatment option for these patients.

How it works

The RNS System, which surgeons place underneath the scalp and has electrodes leading to seizure-causing areas of the brain, continuously monitors brain electrical activity.

After it identifies a preprogrammed abnormal pattern of electrical activity in the brain, it delivers small shocks to suppress seizures before they actually occur.

Unlike other neurostimulator devices, doctors can re-program and customize it to each patient without performing additional surgeries. 

Other promising findings

While Smith and his colleagues eagerly await the FDA’s recommendations for the device, they also look forward to further exploration of an exciting finding related to neurostimulation, which was reported in the New England Journal of Medicine.

In addition to evaluating neurostimulation for epileptic seizures, researchers from the University of California at Los Angeles also stimulated parts of the brain related to learning and memory, and found that electrical stimulation improved spatial, or visual, learning.

This finding reveals the potential of neurostimulation, but Smith says further research will be necessary to determine its full therapeutic capabilities.

March 2012