Non-pharmacologics for Seizure

Question 1

Non-pharmacologic are reserved for ___________

Answer 1

Medication refractory epilepsy

Pharmacologics are the mainstay

Question 2

List 4 non-pharmacological treatments for seizures:

Answer 2

1. Ketogenic diet
2. Vague nerve stimulation (VNS)
3. Responsive neurostimulator system (RNS) - NA in Sg
4. Surgery

Question 3

Ketogenic Diet

• What is it?
• How does it work?
• Challenges

Answer 3

• Diet comprising low carbohydrate, high fat
• Forces the body to burn fat instead of carbohydrates, which produces ketone bodies which are then used by the brain as an energy source (instead of glucose) => induction of ketosis
• However, challenging to adhere long term

Question 4

Ketogenic Diet

• Benefits shown in?

Answer 4

Prevention of seizures mainly in young children whose seizures could not be controlled by medications

Question 5

Vagus nerve stimulator

• What is it?
• How does it work?

Answer 5

• Vagus nerve stimulation to influence neurotransmitter release

How it works:

• Electrodes attached around left branch of vagus nerve as well as connected to programmable stimulator
• Stimulator delivers cyclical stimulation
• During seizure, ‘on demand’ stimulation can be achieved by placing a magnet next to subcutaneously implanted stimulator

Question 6

Vagus nerve stimulator

• Used in?

Answer 6

Use indicated only for intractable focal seizures

Question 7

Responsive neurostimulator system (RNS)

• What is it?
• How does it work?

Answer 7

• NeuroPace stimulator implanted in the skull under the scalp and leads implanted in the brain (INVASIVE)
• Continuously monitors electrical activity in the brain, detects patient-specific patterns, delivers brief pulses of stimulation when it detects activity that could lead to a seizure

Question 8

Responsive neurostimulator system (RNS)

• Used in?

Answer 8

New adjunctive therapy to reduce the frequency of partial onset seizures, in patients who have:

• Undergone diagnostic
  testing that localized =<2 epileptogenic foci
• Refractory to >=2 epileptic medications
• Have frequent and disabling symptoms

Question 9

Epilepsy surgery

• Useful in?

Answer 9

• Selected forms of epilepsy (focus/localized, NOT generalized), to achieve improvement of symptoms or seizure-free status
• Usually advocated as early therapy for specific epileptic syndromes: temporal lobe, frontal lobe
• Typically, last option for med refractory cases

However, there will be collateral damage - functions lost