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User:Karmattol/Other Epilepsy Treatments

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Other treatment

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Ketogenic diet- a high fat, low carbohydrate diet developed in the 1920s, largely forgotten with the advent of effective anticonvulsants, and resurrected in the 1990s. The mechanism of action is unknown. It is used mainly in the treatment of children with severe, medically-intractable epilepsies.

Electrical stimulation [1]- methods of anticonvulsant treatment with both currently approved and investigational uses. A currently approved device is vagus nerve stimulation (VNS). Investigational devices include the responsive neurostimulation system and deep brain stimulation.

Vagus nerve stimulation (VNS)- The VNS (US manufacturer = Cyberonics) consists of a computerized electrical device similar in size, shape and implant location to a heart pacemaker that connects to the vagus nerve in the neck. The device stimulates the vagus nerve at pre-set intervals and intensities of current. Efficacy has been tested in patients with localization-related epilepsies demonstrating that 50% of patients experience a 50% improvement in seizure rate. Case series have demonstrated similar efficacies in certain generalized epilepsies such as Lennox-Gastaut syndrome. Although success rates are not usually equal to that of epilepsy surgery, it is a reasonable alternative when the patient is reluctant to proceed with any required invasive monitoring, when appropriate presurgical evaluation fails to uncover the location of epileptic foci, or when there are multiple epileptic foci.

Responsive Neurostimulator System (RNS) (US manufacturer Neuropace) consists of an computerized electrical device implanted in the skull with electrodes implanted in presumed epileptic foci within the brain. The brain electrodes send EEG signal to the device which contains seizure-detection software. When certain EEG seizure criteria are met, the device delivers a small electrical charge to other electrodes near the epileptic focus and disrupt the seizure. The efficacy of the RNS is under current investigation with the goal of FDA approval.

Deep brain stimulation (DBS) (US manufacturer Medtronics) consists of computerized electrical device implanted in the chest in a manner similar to the VNS, but electrical stimulation is delivered to deep brain structures through depth electrodes implanted through the skull. In epilepsy, the electrode target is the anterior nucleus of the thalamus. The efficacy of the DBS in localization-related epilepsies is currently under investigation.

Noninvasive surgery- The use of the Gamma Knife or other devices used in radiosurgery are currently being investigated as alternatives to traditional open surgery in patients who would otherwise qualify for anterior temporal lobectomy[2]

Avoidance therapy- Avoidance therapy consists of minimizing or eliminating triggers in patients whose seizures are particularly susceptible to seizure precipitants (see above). For example, sunglasses that counter exposure to particular light wavelengths can improve seizure control in certain photosensitive epilepsies[3]

Warning systems- A seizure response dog is a form of service dog that is trained to summon help or ensure personal safety when a seizure occurs. These are not suitable for everybody and not all dogs can be so trained. Rarely, a dog may develop the ability to sense a seizure before it occurs.[4]. Development of electronic forms of seizure detection systems are currently under investigation.

Alternative or complementary medicine- A number of systematic reviews by the Cochrane Collaboration into treatments for epilepsy looked at acupuncture,[5] psychological interventions,[6] vitamins[7] and yoga[8] and found there is no reliable evidence to support the use of these as treatments for epilepsy. Further studies are needed on the subject.

  1. ^ Theodore WH, Fisher RS (2004). "Brain stimulation for epilepsy". Lancet Neurol. 3: 111–118.
  2. ^ Regis, J., M. Rey, F. Bartolomei, V. Vladyka, R. Liscak, O. Schrottner and G. Pendl (2004). "Gamma knife surgery in mesial temporal lobe epilepsy: a prospective multicenter study". Epilepsia. 45: 504–515.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Takahashi, T. and Y. Tsukahara (1992). "Usefulness of blue sunglasses in photosensitive epilepsy". Epilepsia. 33: 517–521.
  4. ^ Barriaux, Marianne (2006-10-16). "Dogs trained to warn of an imminent epileptic fit". The Guardian. Retrieved 2006-11-24. {{cite news}}: Check date values in: |date= (help)
  5. ^ Cheuk D, Wong V (2006). "Acupuncture for epilepsy". Cochrane Database Syst Rev (2): CD005062. doi:10.1002/14651858.CD005062.pub2. PMID 16625622.
  6. ^ Ramaratnam S, Baker GA, Goldstein LH (2005). "Psychological treatments for epilepsy". Cochrane Database Syst Rev (4): CD002029. doi:10.1002/14651858.CD002029.pub2. PMID 16235293.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Ranganathan LN, Ramaratnam S (2005). "Vitamins for epilepsy". Cochrane Database Syst Rev (2): CD004304. doi:10.1002/14651858.CD004304.pub2. PMID 15846704.
  8. ^ Ramaratnam S, Sridharan K (2000). "Yoga for epilepsy". Cochrane Database Syst Rev (3): CD001524. doi:10.1002/14651858.CD001524. PMID 10908505.
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