Purple Day: Epilepsy treatments you need to know about

March 26th is celebrated globally as Purple Day with the intention of spreading awareness about epilepsy. On this Purple Day, we give you a low-down on the available and future treatment options for this neurological disorder.

Editorial Team | Published: March 26, 2019 3:35 pm

An epileptic seizure comes with symptoms like convulsion, passing out, tingling, numb sensations in the body, etc. ©Shutterstock

If you want to trace the origin of epilepsy, history will take you 3000 years back. Characterised by unexplained seizures popularly known as epileptic fits, epilepsy is a largely misunderstood neurological disorder, shrouded with myths and stigma. It is strange that in this century and age of information boom, we still know very little about epilepsy, which ranks 4th among the nerve diseases, globally. An estimate by the Epilepsy Foundation reveals that this disease affects 65 million people worldwide and a third of them experience uncontrollable seizures because the remedial measures have no impact on them. These figures call for action for sure and the first step should be educating people about epilepsy and dispelling the myths shrouding it. On the occasion of Purple Day this year, we share with you all that you need to know about the treatment options for epilepsy.

DECODING EPILEPSY AND SEIZURES

Epilepsy is a neurological disease that is manifested through episodes of seizures. When there are two episodes of seizure which are not triggered by a known cause like fever, withdrawal symptoms, or severely low blood pressure, the condition is diagnosed as epilepsy.

The first line of diagnosis is done on the basis of a detailed medical history and description from the eye witnesses of the patient’s epileptic fit. Apart from checking pulse rate and blood pressure, the neurologist also looks for other signs and symptoms of nerve disorder. The confirmatory tests include imaging procedures like electroencephalogram (EEG), CT scan, MRI and positron emission tomography (PET). While an EEG spots signals from the brain neurons and figures out the type of epilepsy, a CT scan or MRI is used to hint at the cause of the disease. A PET is suggested to find out the brain centres responsible for or involved in seizures.

The physiology behind a seizure is well-explained by Cleveland Clinic experts. As stated by them, our brain processes almost 70,000 thoughts daily. For successful processing, 100 billion neurons are required to connect to 500 trillion points or more. This function leads to the generation of a significant amount of electricity. But if there is a glitch in this system, the outcome is a seizure. An episode of seizure comes with symptoms like convulsion and passing out. However, there could be other manifestations too: Tingling or a numb sensation in the body, hearing clicking and ringing sounds even when there don’t exist. The normal duration of a typical seizure episode is less than 2 minutes.

AVAILABLE TREATMENTS

According to neurologists, one-time occurrence of an epileptic episode doesn’t necessitate medication. However, if there is a second instance of seizure, drugs are prescribed. In severe cases when people don’t respond to medicines, surgical intervention may be required.

Drugs

A single drug therapy, known as monotherapy, is prescribed for epilepsy patients. The conventional medicines for monotherapy include phenytoin, oxcarbazepine, valproate, phenobarbitone and carbamazepine which aim to control seizures. A combination of these drugs is suggested when monotherapy fails. The dosage depends on the severity of the condition. It is reduced through three to six months and the medicines are withdrawn when the patients stop experiencing seizure. Though majority of the epileptic patients do not require drugs after 3-5 years, some may need to take them throughout life because they experience relapses quite often. The general side effects of the drugs include vision problems, an upset tummy, fatigue, and sleepiness among others.

Surgical intervention

This is rarely required. A very small section of epilepsy patients doesn’t respond to drug therapy. Doctors opt for surgery in their cases after pinpointing seizure-prone brain areas with the help of EEG. Here are the types of surgical intervention used for this neurological disorder:

Removal of seizure focus: In this process, the part of the brain with disturbed signals is identified and surgically removed. It is the most common type of epilepsy surgery.

Multiple Subpial Transection (MST): In some cases, the affected brain part cannot be removed. This is where this surgical procedure comes into play. The process involves creation of incision in a brain part which prevents seizure impulses from reaching the neighbouring areas.

Lesionectomy: When brain lesions including scars from a head injury or infection, tumours, abnormal blood vessels, and hematomas, are the reason behind epilepsy, this surgery is used. It removes the lesion.

Minimally-invasive procedure
This method is recommended for patients who cannot be considered for surgery.

Vagus nerve stimulation (VNS): This procedure requires the surgeon to implant a device called vagus nerve stimulator under the patient’s chest skin. It controls the electrical signals that the vagus nerve sends to the brain bringing down seizure incidences by 20-40 per cent.

FUTURE OPTIONS

With advanced research and development in the field of neuroscience along with other medical genres, we can expect more evolved treatment and diagnostic options for epilepsy in the near future. Some of the new and future options include robotic surgery, neuro-navigation and neuro-endoscopy among others. Here we talk about two treatment options which may come as a boon to epilepsy patients.

Brain implant

An electronic device implanted directly into the brain can detect, stop and even prevent epileptic seizures, as demonstrated by researchers, reports ANI. The researchers from the University of Cambridge, the École Nationale Superieure des Mines and INSERM in France, implanted the device into the brains of mice, and when the first signals of a seizure were detected, delivered a native brain chemical which stopped the seizure from progressing.

In the current work, the researchers used a neurotransmitter which acts as the ‘brake’ at the source of the seizure, essentially signalling to the neurons to stop firing and end the seizure. The drug is delivered to the affected region of the brain by a neural probe incorporating a tiny ion pump and electrodes to monitor neural activity.

The researchers found that seizures could be prevented with relatively small doses of drug representing less than 1% of the total amount of drug loaded into the device. This means the device should be able to operate for extended periods without needing to be refilled.

Cannabis

According to a recent IANS report, The Council of Scientific and Industrial Research (CSIR) is doing a research on the medicinal use of cannabis for treating diseases like cancer, epilepsy and sickle cell anaemia. For the research, CSIR has selected a certain variety of cannabis plants like THC and CBC which are a class of compounds known as cannabinoids, found in abundance in the cannabis plant.

“Not all cannabis plants can be used for medical purpose. We have already started collecting and cultivating selected breed of cannabis. Trials are also being conducted on animals and once it is completed, we will place it for DCGI’s (Drug Controller General of India) approval,” said Ram Vishwakarma, Director, CSIR-IIIM (Indian Institute of Integrative Medicine).

The CSIR-IIIM Director further said that on a primary basis, the impact of the drugs procured from cannabis will be conducted first in Tata Memorial Hospital, Mumbai.

(With inputs from ANI and IANS)

Published: March 26, 2019 3:35 pm

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