LOS ANGELES (Feb. 7, 2023) — Many think of epilepsy, a neurological disorder affecting 3.4 million Americans, as a chronic condition marked by occasional seizures. But the disease can be deadly, so it is essential for patients to get their seizures under control with proper treatment, said Lisa Bateman, MD, director of the Cedars-Sinai Health System Surgical Epilepsy Program.
“One of the biggest risks for people living with epilepsy is what’s called sudden unexpected death in epilepsy, or SUDEP, which affects about 1 in 1,000 people with epilepsy every year,” Bateman said. “The exact mechanisms of why people die suddenly from epilepsy are still not fully understood. What we do know is that seizure control is the most important thing we can do to reduce the risk, whether that’s through medications, surgeries or other interventions.”
Epileptic seizures are caused by uncontrolled electrical activity originating in a specific part of the brain (focal epilepsy) or from broad areas across both sides of the brain simultaneously (generalized epilepsy), Bateman said. Some patients with epilepsy might go a year or more between seizures, while others experience dozens each day.
“Some seizures may affect basic functions of the brain such as movement, speech or vision,” Bateman said. “They may cause a person to lose consciousness, to fall, to injure themselves. And there is the classic seizure type that everybody thinks of, which is the full-body convulsion type of seizure, where people may be prone to injuries and prolonged recovery time after the seizures, as well. This type of seizure, called a generalized tonic-clonic seizure, is also the one most associated with an increased risk of SUDEP.”
Only about two-thirds of patients have their seizures well controlled with medications, and patients whose seizures remain uncontrolled after trying two different anti-seizure medications are unlikely to benefit from trying others, Bateman said.
An epilepsy specialist can offer patients more effective options, but many patients live with uncontrolled seizures for 15 or 20 years before getting the help they need. In addition to SUDEP, these patients risk serious injury if they have a seizure in the wrong place or at the wrong time—while cooking, climbing a ladder, swimming or bathing, or crossing a busy street.
“We’re still seeing people go a tremendously long time with uncontrolled seizures before they go to see an epilepsy specialist,” Bateman said. “To get care from someone who’s specialized in epilepsy, when the regular avenues of medication treatment aren’t working, is really important.”
The most successful type of epilepsy surgery, resective epilepsy surgery, can eliminate seizures in up to 70% to 80% of patients whose seizures are focused in the temporal lobe of the brain and 30% to 50% of patients whose seizures originate in other areas of the brain. Even for those who do not become seizure-free, epilepsy surgery can still reduce the frequency and severity of their seizures.
“We do some testing to identify where in a person’s brain their particular seizures come from, and then we have a surgical procedure to remove that abnormal area of the brain,” Bateman said.
Almost as effective, and a good option for people whose seizures come from certain small, specific areas in the brain, is a laser ablation procedure, where a laser probe, guided by magnetic resonance imaging, is inserted into the brain to burn away the area causing the seizures.
“People whose seizures come from an area of the brain that performs a crucial function like control of speech or movement, and patients who have seizures that come from multiple different areas in the brain, may be candidates for a neuromodulation or neurostimulation procedure,” Bateman said. “There are different types of stimulation devices placed within the brain, on the surface of the brain or on major nerves attached to the brain that can reduce the frequency and severity of a person’s seizures.”
Around 40% to 50% of patients using these devices experience significant improvement in their seizures, Bateman said. And the more control patients gain over their seizures, the lower their risk of injury or death.
“Anyone who is having difficulty with controlling their seizures, particularly if they’ve failed a trial of two seizure medications, should be referred or seek out assessment by a dedicated epilepsy center such as the one we have here at Cedars-Sinai,” Bateman said. “We can evaluate the person’s seizures and come up with a management plan to better control their seizures and improve their lives.”
Read more on the Cedars-Sinai Blog: New Horizons in Refractory Epilepsy Therapy
