Brain stim­u­la­tion for epilep­tic seizures

The Fresno Bee - - Life -

Q: How does deep brain stim­u­la­tion Q: for epilepsy work? Who’s a good can­di­date for this treat­ment? Is it ef­fec­tive?

A: Deep brain stim­u­la­tion A: is a tech­nique that uses a wire placed per­ma­nently in the brain to send elec­tri­cal pulses to the brain. It has been ap­proved by the Food and Drug Ad­min­is­tra­tion to treat epilepsy that hasn’t re­sponded to other forms of ther­apy. In most peo­ple, deep brain stim­u­la­tion doesn’t com­pletely elim­i­nate seizures caused by epilepsy, but it can sig­nif­i­cantly re­duce them.

Epilepsy is a cen­tral ner­vous sys­tem dis­or­der. In a per­son with epilepsy, nerve cell ac­tiv­ity in the brain be­comes ab­nor­mal, caus­ing seizures and some­times loss of con­scious­ness. The symp­toms of a seizure can vary widely from one per­son to an­other. For ex­am­ple, some peo­ple with epilepsy stare blankly for a few sec­onds dur­ing a seizure or ap­pear con­fused. Oth­ers may lose con­scious­ness and have repet­i­tive jerk­ing of their arms and legs.

Even mild epilepsy re­quires treat­ment be­cause seizures can be dan­ger­ous dur­ing ac­tiv­i­ties such as driv­ing. Med­i­ca­tion to re­duce or elim­i­nate seizures usu­ally is the first step in treat­ment. For about two-thirds of peo­ple with epilepsy, seizures are ef­fec­tively con­trolled with the first or se­cond anti-seizure drug they try.

When med­i­ca­tion doesn’t pro­vide ad­e­quate seizure con­trol, surgery may be an op­tion. Epilepsy surgery typ­i­cally in­volves re­mov­ing the area of the brain that’s caus­ing seizures. That ap­proach only works, how­ever, when the place within the brain that’s trig­ger­ing the seizures can be iden­ti­fied clearly. In some peo­ple, that’s not pos­si­ble. It’s those in­di­vid­u­als who are most likely to ben­e­fit from deep brain stim­u­la­tion.

Deep brain stim­u­la­tion for epilepsy in­volves one surgery where you are asleep. Dur­ing surgery, the sur­geon im­plants a thin wire lead with sev­eral con­tacts, or elec­trodes, at the tip into an area deep within the brain called the “thal­a­mus.” The thal­a­mus is ba­si­cally a re­lay sta­tion that dis­trib­utes sig­nals that come from the body’s senses to other re­gions of the brain.

Af­ter an imag­ing exam confirms that the elec­trodes are placed prop­erly, a bat­tery-op­er­ated de­vice called a pulse gen­er­a­tor is im­planted un­der the skin near the col­lar­bone. Wires run­ning from the elec­trodes in the brain are placed un­der the skin and con­nected to the gen­er­a­tor. The gen­er­a­tor is pro­grammed to send con­tin­u­ous elec­tri­cal pulses to the brain.

A large clin­i­cal re­search trial found that in peo­ple with epilepsy whose seizures didn’t re­spond to other ther­a­pies, around 15 per­cent be­came seizure­free for more than six months af­ter deep brain stim­u­la­tion. Although that num­ber is fairly low, it rep­re­sents sig­nif­i­cant – of­ten life-chang­ing – im­prove­ment for those in­di­vid­u­als.

But the goal of deep brain stim­u­la­tion typ­i­cally is not com­plete re­lief of all seizures. In­stead, it’s used to re­duce the num­ber of seizures a per­son has. The same clin­i­cal trial showed that be­tween 50 and 60 per­cent of pa­tients in the study had a de­crease in their seizures in re­sponse to deep brain stim­u­la­tion. The re­search also showed that within the group who did re­spond, the num­ber of seizures they had con­tin­ued to de­crease over time.

Although deep brain stim­u­la­tion is a ma­jor sur­gi­cal pro­ce­dure, the risks in­volved are fairly low. And if found to be in­ef­fec­tive, it’s re­versible.

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