Finding solutions beyond medication for intractable epilepsy
While medications help control seizures in many people with epilepsy, approximately 40 to 50 percent have what is known as intractable epilepsy and 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, including the following:
Vagus nerve stimulation
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.
How it works: Vagus nerve stimulation functions like a pacemaker does for the heart. It is surgically placed under the skin and attached to the vagus nerve. Once attached, it sends regular pulses to the brain, according to each patient’s needs, to prevent seizures from occurring.
The stimulator’s settings can be changed as needed via a special wand, with no additional surgery needed.
RNS System (or NeuroPace)
Rush was the first to combine the FDA-approved neurostimulator called the RNS system (also referred to as NeuroPace) with a mapping method and brain activity tracking developed at the Medical Center.
How it works: The RNS System, which neurosurgeons place underneath the scalp and has electrodes leading to seizure-causing areas of the brain, continuously monitors brain electrical activity.
It detects seizure symptoms before they occur and suppresses the seizure with small shocks that are unnoticeable to the patient. The device, which was researched at Rush for approval, has been shown to reduce seizures by at least 50 percent.
Experts at Rush found a way to make the treatment even more effective: They designed a brain mapping system to more precisely show where to implant NeuroPace. They also designed a detection system within NeuroPace that can record patients’ brain activity 24/7 and show where seizures are originating, allowing for more effective surgical treatment in future.
The combination of RNS plus the electrode placement planning system and brain activity tracking eliminated seizures in nearly half of the patients enrolled in a decade-long clinical trial conducted prior to RNS approval.