Non Pharmacological Treatment Of Epilepsy Flashcards
Name four non-p treatments for epilepsy
Vagal nerve stimulation (VNS)
Deep brain stimulation DBS
resective surgery/ gamma knife surgery
Kerogenic diet
Give a simple definition for epilepsy
The tendency to have recurrent seizures
When is VNS a suitable treatment for epilepsy?
In those whose seizures are not fully controlled with AEDs
In those with focal or generalised onset seizures
As an adjunctive to AEDs
What is the aim of VNS treatment in those with refractory eplilepsy
Reduce the seizure frequency or intensity or negative symptoms of seizures
Where is the VNS stimulator implanted ? And where is it connected to ?
Underneath a pocket of skin Under the collarbone or close to the armpit
Connected with wires to the left Vagus nerve in the neck
How does the VNS work?
Sends regular , mild electric pulses to the nerve in order to interrupt electrical irregularities in brain to prevent seizures
What are the drawbacks of VNS?
Not beneficial to whole spectrum of patients
Not possible to know who will have reduction in seizures
Can take a months to 2 years to achieve optimum control
Mild side effects
Should DBS be used as mono-therapy or adjunctively to AEDs
Adjunctively
For which patients is DBS suitable ?
Those unable to control seizures with AEDs
Those with focal onset
May be suitable for those unsuitable for resective surgery
How does DBS work?
Implant electrodes in to specific area of brain affected
Control excess electrical activity by using regular impulses to reduce frequency and severity of seizures
Where is the DBS device implanted
Under skin below collar bone
What effect has clinical trials for DBS shown?
Some much less frequent
For others may reduce their seizure a little
For others it has no effect
What is the downside of DBS.?
Not beneficial to all patients
Not possible to know who will show benefit
Not widely available in the uk
Efficacy evidence is lacking
Under what restrictions should DBS be used?
Special arrangements for clinical governance, consent, and audit or research (nice guidelines 2012)
For who is epilepsy surgery suitable ?
Those with focal onset seizures
If several AEDs trialled and non have significant reduced seizure frequency (50%)
Post traumatic epilepsy and those with a physical cause
What does epilepsy surgery aim to do?
Stop or reduce the occurrence of seizures
What is a warder test?
A neurosurgeon freezes part of the brain that is going to be removed to see if the individual can function without it
What percentage of those who have surgery become seizure free?
70%
What types of surgical procedures can be performed?
Resective
Disconnective
What are the types of resective surgery
Lobectomies: temporal , frontal, etc
Topectomy( excision of area tailored to the seizure focus)
Hemispherectomy: removal of one half of the brain
Are resective or dis connective procedures more likely to result in a cure?
Resective as it excises the seizure focus itself
What types of dis connective procedures are available?
Corpus callostomy
Multiple pail transections
What are the drawbacks of epilepsy surgery?
High risk of damage : ie stroke, death, paralysis, worsening of epilepsy
Ethical implications ie loss of carers
Approx 50% of patients recommended are unsuitable (fail the warder test)
What is gamma knife surgery?
Radio surgical procedure
Narrow beams of radiation target precise volume of tissue in the brain
Highly focused to prevent damage to surrounding areas
