If you or someone you care about has been diagnosed with epilepsy, you’re probably wondering about the long-term outlook. There is presently no cure for epilepsy. But there is good news. Between 70 and 80 percent of people diagnosed with epilepsy are able to control their symptoms effectively with the right drug or combination of drugs. Patients are able to lead relatively normal lives with careful symptom management. Some are even able to stop taking drugs, eventually.
New Hope for An Ancient Disease
The historical record shows that epilepsy has always been with us. Throughout most of human history, physicians were helpless to treat this neurological disorder. But the 20th century ushered in a new era in the diagnosis and treatment of epilepsy. The first “modern” anti-epileptic drugs (AEDs) were introduced about a century ago. By the 1920s doctors had learned to monitor and interpret the electrical activity of the brain. Since then, options to treat seizure disorders have grown. In the past decade alone, the number of new drugs to combat epileptic seizures has more than doubled. Right now, there are about 20 drugs approved for treatment of epilepsy in the United States.
Opportunities for minimizing epilepsy’s impact increase with the introduction of each new drug. For decades, most AEDs worked by affecting a particular aspect of nerve cell (neuron) function. This shared “mechanism of action” targeted key structures in neurons called sodium channels. These structures play an important role in the conduction of electrical signals among neurons. Recently, new drugs have been approved. They help prevent the inappropriate firing of neurons through newly discovered mechanisms of action.
Recent research shows that treating partial onset seizures with two or more drugs that have different mechanisms of action is more effective than relying on one mechanism alone. Partial-onset seizures comprise about two-thirds of epilepsy cases. Many of the newest drugs are approved for adjuvant (“add-on”) use. This means they are intended for use in combination with other drugs. Some older drugs are now considered first-line therapy. Many newer drugs are used as adjuvants. Adjuvants are usually prescribed after an initial drug fails to control symptoms adequately. However, most epilepsy patients can be treated successfully with just one drug.
Scientists are constantly learning more about the processes underlying both normal and abnormal brain activity. By better understanding how neurons communicate, scientists are able to devise safer, more effective approaches to seizure control. For example, scientists recently published research that deepens our understanding of certain nerve cell proteins involved in signaling among nerves.
Epilepsy is characterized by seizures. Seizures are often described as electrical storms in the brain. Brain cells ordinarily communicate with each other by using messenger chemicals and electrical impulses. Essentially, it’s up to each individual neuron to “decide” whether it will pass a given signal along to its neighbors, or allow the signal to die. Each individual neuron has the ability to “edit” the message, choosing not to pass it along. Or it can pass the signal to its neighbors. This is called propagation. During a seizure, waves of electrical signals sweep across portions of the brain. It is as if this ability to edit has been temporarily paralyzed.
Recent research provides new insight into the mechanisms by which neurons propagate electrical signals, or not. By deepening our understanding of these processes, scientists hope to identify promising new targets for drug development.
Up to 60 percent of epileptic patients can eventually discontinue AEDs. They need to have been seizure-free for two to four years. Epilepsy is not a single disease, though. It is a large group of diseases characterized by seizures. Some forms are more treatable than others.
Drug therapy is the first-line treatment for epilepsy. But alternative therapies exist. Some forms of epilepsy respond well to a modified diet, for example. The ketogenic diet relies on the avoidance of carbohydrates to alter the way the body metabolizes energy sources. It may be effective against certain forms of severe epilepsy in children. This old approach is experiencing renewed interest among doctors.
Avoiding alcohol and getting enough sleep can make an important difference for some patients. Techniques such as biofeedback and relaxation can also help some patients.
Between 70 and 80 percent of patients can be treated effectively with AEDs. But that means that the remaining 20 to 30 percent do not achieve adequate control this way. In these cases, it may be necessary to consider surgery to address problematic areas of the brain. Various procedures exist for this. Some involve removal of a particular lobe or damaged portion of the brain. Another involves cutting certain connections within the brain in order to prevent seizures from spreading from one hemisphere to another.
Another option involves the implantation of a device called a vagus nerve stimulator. This device was introduced in the late 1990s. Electrical wires are surgically implanted in the chest wall and connected to the vagus nerve, and a portable device delivers a tiny amount of current to help “short-circuit” seizure activity. About one-quarter of patients achieve near complete relief from seizures with the device. About 40 percent of patients experience a 50 percent reduction in seizure activity.