Diagnosis and Treatment

Epilepsy surgery has been a treatment used to help control seizures for over 100 years! Improvements in modern methods have made epilepsy surgery safer and more available than ever before. A number of brain surgeries can treat certain kinds of seizures that cannot be controlled with medication or other forms of treatment. Some types of epilepsy surgery may lead to seizure freedom and an improved quality of life in up to 80% of people with drug resistant epilepsy.

Epilepsy surgery can be overwhelming to consider. Many people are unsure if surgery can help them, but surgery needs to be considered as an option for people whose seizures are not controlled with medications, dietary therapy, or implanted devices.

Download this factsheet to learn about how epilepsy surgery works, when surgery may be recommended, and what types of surgery may help.

Surgery

Epilepsy surgery has been a treatment used to help control seizures for over 100 years! Improvements in modern methods have made epilepsy surgery safer and more available than ever before. A number of brain surgeries can treat certain kinds of seizures that cannot be controlled with medication or other forms of treatment. Some types of epilepsy surgery may lead to seizure freedom and an improved quality of life in up to 80% of people with drug resistant epilepsy.

Epilepsy surgery can be overwhelming to consider. Many people are unsure if surgery can help them, but surgery needs to be considered as an option for people whose seizures are not controlled with medications, dietary therapy, or implanted devices.

Download this factsheet to learn about how epilepsy surgery works, when surgery may be recommended, and what types of surgery may help.

Dietary Therapy

Dietary therapy is an approach to help control seizures, usually in conjunction with seizure medications. · The classic ketogenic diet, a special high-fat, low-carbohydrate diet, is prescribed and monitored by a physician and nutritionist and can help control seizures in some people. It can help both children and adults with refractory seizures. · Additionally, the modified Atkins Diet, which has some similar components to the traditional ketogenic diet, can be effective.

Each diet is personalized for the individual and should be done under medical supervision.

Download this factsheet to learn about the 4 major types of dietary therapy used to treat epilepsy, including the ketogenic diet, Medium-chain triglyceride diet (MCT), Modified Atkins Diet (MAD), and Low Glycemic Index Treatment (LGIT).

Devices

Neuromodulation is another option for controlling seizures. This therapy involves using a device to send small electrical currents to the nervous system.

VNS Therapy® (also called vagus nerve stimulation) has been approved by the U.S. Food and Drug Administration (FDA) as an add-on therapy for adults and children 4 years and older. It is approved to treat focal or partial seizures that do not respond to seizure medications. This is called drug-resistant epilepsy or refractory epilepsy. Vagus nerve stimulation (VNS) may prevent or lessen seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. The therapy consists of a device that is implanted under the skin in the left chest area. An electrode or wire is attached to the generator device and placed under the skin. The wire is attached or wound around the vagus nerve in the neck. The device is programmed in the outpatient clinic to deliver pulses or stimulation at regular intervals. A person does not need to do anything for this device to work. A person with a VNS device is usually not aware of the stimulation while it is working. If a person is aware of when a seizure happens, they can swipe a magnet over the generator in the left chest area to send an extra burst of stimulation to the brain. For some people this may help stop seizures. Download this factsheet to learn about VNS, how it works, and who can use it./a>

The RNS System has been approved by the FDA as an add-on therapy for adults 18 years and older. It is approved to treat focal or partial seizures that do not respond to seizure medications. The RNS® System is a smart device that is adjustable and reversible. Where it is placed and how it is used is tailored to each person. It learns what is going on in a person’s brain, and settings can be adjusted for each person. Most comprehensive epilepsy centers that provide epilepsy surgery can also offer the RNS® System. Before having the RNS placed, a person must go though detailed testing to see where their seizures arise in the brain.

The RNS® System is similar to a heart pacemaker. It can monitor brain waves, then respond to activity that is different from usual or that looks like a seizure.

A device or stimulator is placed in the bone covering the brain. Tiny wires or leads are placed in one or two places on top of the brain where seizure activity may begin. These wires connect to the stimulator. Once the wires and device are placed, nothing can be seen.

The system can give small pulses or bursts of stimulation to the brain when anything unusual is detected. This can stop seizure activity before the actual seizure begins. Or it could stop seizure activity from spreading from a small focal seizure to a generalized seizure.

People cannot feel the stimulation once it’s programmed. It doesn’t cause pain or any unusual feelings.

It’s not permanent. It can be turned off or removed if it doesn’t work or a person doesn’t wish to use it any longer.

Download this factsheet to learn about who can use RNS and how the device works.

The DBS device is placed by a neurosurgeon during an operation. Thin wires (called electrodes) carry electrical impulses from the neurostimulator device directly to the brain to stop brain signals that causes seizures. The neurostimulator device is battery operated. It can be programmed like a tiny computer (similar to a cardiac pacemaker). The device is programmed by your doctor or nurse to deliver tiny electrical impulses. · These electrical impulses help to stop seizures from beginning or spreading to different areas of the brain. · The DBS® System is manufactured by Medtronic. Additional information for patients and physicians is available on their website.

Medical Cannabis

Colorado is one of many states that allows medical use of cannabis. People living with uncontrolled seizures who have previously attempted other forms of treatment have reported beneficial effects and reduced seizure activity, especially with cannabidiol (CBD) oil. The Epilepsy Foundation of Colorado & Wyoming supports further research on CBD/medical marijuana. Anyone contemplating these options should conduct research to reach an informed treatment decision.

  • Medical marijuana (also called medical cannabis) is whole plant marijuana or extracts from the plant used for medical purposes.
  • Cannabinoids are substances in cannabis that act on cells in the body, including the brain. The two main cannabinoids used in medicine are tetrahydrocannabinol (THC) and cannabidiol (CBD).
  • Evidence from laboratory studies, anecdotal reports, and small clinical studies over a number of years suggest that cannabidiol (CBD) could potentially help control seizures. The FDA recently approved the use of Epidiolex (a plant-based formulation of CBD) to treat seizures for people 2 years of age and older with Dravet syndrome and Lennox-Gastaut syndrome (LGS).
  • Medical cannabis, CBD, and THC all have possible side effects. The most common side effects of CBD included sleepiness, diarrhea, fatigue, and decreased appetite.
  • CBD also interacts with some other seizure medicines. Careful monitoring of CBD is needed.
  • When conventional treatments do not work to control seizures, as is the case for roughly 30% of people with epilepsy, it is not unreasonable to consider CBD oil.

Click here to find the answers to these frequently asked questions:

  • What is medical cannabis?
  • What is CBD?
  • What is the Epilepsy Foundation’s position on medical cannabis and CBD?
  • What is the legal status of CBD?
  • What is the legal status of medical cannabis?
  • Are there any side effects or drug interactions associated with medical cannabis or CBD?Will medical cannabis or CBD replace my other medications?
  • What do I do if my physician or prescribing provider will not recommend medical cannabis or CBD?
  • Is there any difference in the commercial-grade CBD I purchase online or from a health food store and the dispensary-grade CBD sold in medical dispensaries?
  • Are there currently any FDA-approved therapies derived from CBD?
  • How is Epidiolex® different from commercial grade CBD sold over-the-counter and in dispensaries? 

Learn about the Epilepsy Foundation’s state and federal advocacy efforts on removing barriers to cannabis research and supporting access to medical cannabis (marijuana) in consultation with the treating physician.