Posts Tagged Epilepsy Treatment

[WEB SITE] Epilepsy Minimally Invasive Surgery in Israel !

Epilepsy Treatment in Israel

Epilepsy is a spectrum of brain disorders which cause the development of abnormal activity of convulsions. Herzliya Medical Center Private Hospital conducts progressive minimally invasive techniques for the treatment of epilepsy.

What Is Epilepsy

Epilepsy is a disease of the central nervous system, characterized by a violation of the physiological activity of the brain cells. The main manifestation of epilepsy are seizures; the severity, frequency and nature of the disease can vary significantly.

Focal seizures are caused by abnormal activity at one part of the brain. The seizures appear in the form of sensory disorders, a brief loss of consciousness or involuntary contractions of the muscles of the upper or lower limbs. The seizures develop in response to pathological activity of the brain and may be accompanied by falling, twitching muscles and involuntary urination. Brain surgery for epilepsy is done to people to reduce or to stop the number of seizures they have. Surgery for epilepsy involves removing the part of the brain which causes the seizures or separating the part of the brain which causes seizures from the rest of the brain.

Epilepsy Diagnosis

A single convulsive seizure is not regarded as a sign of epilepsy. An indication for an in-depth diagnosis is a history of two or more seizures not caused by any objective reasons.

Diagnostic Measures:

  • Neurological examination
  • Electroencephalography (EEG). EEG is a graphical recording of the electrical activity of different brain regions. EEG can be performed in the waking state, during sleep, alone or under the influence of a trigger – factor, artificially stimulating seizure activity.
  • Computed tomography of the brain (CT). Before planning brain surgery in Israel, neurosurgeons recommend carrying out a CT test; it lets the neurosurgeon visualize the structure of the brain, as well as to diagnose tumors, hemorrhage, cystic formation, against which the patient may develop seizures.
  • Magnetic resonance imaging (MRI), both standard and functional. Epilepsy surgery usually requires a functional MRI to determine the areas of the brain that regulate the processes of speech, motor skills and other critical functions.
  • Positron emission tomography (PET)
  • Single photon emission computed tomography (SPECT). Experts in the field of neurosurgery in Israel recommend having a SPECT scan as well.

Epilepsy Surgery and Treatment in Israel

Treatment of epilepsy usually begins with medication. For most patients, the chronic long-term administration of antiepileptic drugs (AEDs) can reliably control the disease and prevent attacks or significantly reduce their frequency. With the ineffectiveness of drug therapy, a possible epilepsy surgery is considered. The indications for surgery are seizures that occur despite medication. Brain surgery in Israel for the treatment of epilepsy is carried out in cases when the source is located outside the areas of the brain responsible for vital functions: speech, motor skills, vision or hearing.

Surgery may be performed to isolate a certain part of the brain. Neurosurgery in Israel widely uses intraoperative MRI capabilities; during surgery, MRI is used for monitoring to ensure that the impact is applied on the selected area of ​​the brain.

Herzliya Medical Center practices innovative methods of surgical treatment for epilepsy, which is a kind of stereotactic surgery. For the destruction of the convulsive center in the brain a laser beam is used, which causes the heating of tissues and their destruction. The laser beam serves as a thin catheter and is conducted into the cavity of the skull. Minimally invasive laser techniques do not require prolonged hospitalization, the patient can return to normal life within a couple of days.

via Epilepsy Minimally Invasive Surgery in Israel ! – US Med Times

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[WEB SITE] What Modern Day Challenges Affect Epilepsy Treatment?

epilepsy

Researchers recently published an article in The Lancet Neurology discussing the difficulties facing seizure detection in patients with epilepsy.

Epilepsy is a neurological disorder that is characterised by short repetitive epileptic seizures.  These seizures can be harmful to the individual depending on the circumstances in which they occur, such as a seizure while driving. This disorder is set apart from other neurological disorders since there is a broad range of different physiological changes that can cause it, leading to a large variation in symptoms and making it difficult to treat. While 70% of sufferers can be treated with pharmacological agents, 30% have no reliable anti-epileptic drugs that are effective for their particular type of epilepsy.

In a recent study, Christian Elger and Christian Hoppe determined that a key challenge facing patients is that over 50% of patients under-report the number of seizures they experience, which has a serious impact on how well doctors are able to determine what treatments are most suitable for them. This also calls into question many of the previously published research on epilepsy treatments. They recently published this report in The Lancet Neurology.

Why are Epileptic Seizures Difficult to Detect?

In this personal view, the writers determined that the cause of under-reporting is primarily due to patients, or their caregivers, being unable to identify when seizures are occurring. Seizures can impair consciousness, may occur at night, or the physical symptoms may be so subtle that they are not easily noticed unless professionally trained to do so.

Technologies for Epilepsy DetectionThe gold standard for epilepsy detection is video-electroencephalography (VEEG), where patients have their brain activity monitored for epilepsy-specific activity and trained technicians can test for impairments to consciousness, cognition, language, and memory. Video footage from the VEEG can also be viewed at a later time to spot slight body movements indicative of a seizure. The limitation of this method is that it requires a hospital visit, increasing associated costs, and is only suitable for identifying how frequent a person has a seizure over a given time, it does not address the issue of a person (or their caregiver) being aware they are having a seizure in real time.

Automated System Required

It is clear that the future of seizure detection requires an automated system,  preferably one that patients can wear over the long-term and that will notify them or a nearby center when a seizure occurs. The main barriers to this technology is that a number of the current ambulatory systems for monitoring brain activity can be limited in monitoring time (72 hours) or require labor-intensive analysis of data, although as algorithms for analyzing brain activity improve this limitation will also decrease.

An analysis of movement via home-based video systems, or of various physical data outputs (i.e. accelerometry, magnetometry, gyroscopy, or pressure data) derived from worn sensors have some promise but so far the results have not been consistent.

Surface Electromyography

It appears that one of the most promising methods, which is also viewed favorably by patients, is surface electromyography (SEMG). This method involves self-adhesive sensors that are attached to muscles in areas of the body affected by seizures. Furthermore, multi-modal approaches that combine SEMG, EEG, and electrocardiography have a detection rate over 85% for the majority of seizure types.

Improved Seizure Detection Necessary

It is clear that improved seizure detection is necessary for ensuring that doctors provide the most appropriate treatment to individual patients, as well as ensuring that patients are protected from life-threatening seizures. Improving wearable, ambulatory technologies and advancements in algorithms for the analysis of seizure data will help provide comprehensive support to both physicians and to the patients that they monitor.

Written by Michael Healy, BSc, MSc

Reference: Elger C.E., Hoppe C. Diagnostic challenges in epilepsy: seizure under-reporting and seizure detection. Lancet Neurol 2018; 17: 279–88.

via What Modern Day Challenges Affect Epilepsy Treatment? – Medical News Bulletin | Health News and Medical Research

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[WEB SITE] Medication Adherence Key to Epilepsy Treatment

In assessing the effectiveness of prescribed medication there is a strong emphasis on the ability of the patient to adhere to the regime recommended by the clinician. For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Non-adherence to antiepileptic drugs (AEDs) can result in breakthrough seizures many months or years after a previous episode and can have serious repercussions on an individual’s perceived quality of life. Reasons for non-adherence are complex and multilayered. Patients can accidentally fail to adhere through forgetfulness, misunderstanding, or uncertainty about clinician’s recommendations, or intentionally due to their own expectations of treatment, side-effects, and lifestyle choice.

Adherence in epilepsy

Adherence is acting in accordance with advice, recommendations or instruction. Ways that adherence can be optimized;

  1. Educating individuals and their families and carers in understanding of their condition and the rationale of treatment, reducing the stigma associated with the conditions.
  2. Using simple medication regimes.
  3. Positive relationships between healthcare professionals, the individual with epilepsy and their family and /or carers.
  4. Other measures are; manual telephones follow up, home visits, special reminders, regular appointments/ refill reminders.

While failing to adhere to treatment plans can adversely affect individuals with any general medical condition, Non- adherence to anti-epileptic drugs results to increased risk of status epilepticus (prolonged seizures) resulting into brain damage, SUDEP, risk of injuries, increase rates of admission to hospital due prolonged seizures. The consequences of not taking medication can be more immediate with epilepsy.​

Epilepsy as a chronic condition relies heavily on adherence to medical advice in order to maximize an individual’s quality of life by controlling seizures more effectively while avoiding unwanted side-effects. Treatment of those diagnosed with epilepsy the vast majorities are treated with AEDs and approximately 70% can become seizure-free once the most effective regime is followed.

Monotherapy is viewed as the initial and preferential option for treating epilepsy, the choice of drug depending on seizure type and effectiveness of the drug balanced against possible side-effects. It is difficult to find estimates of how many people are on monotherapy or polytherapy at any one point in time.

However, in one of the cases I encountered that of Sarafina Muthoni from Banana, Kiambu County, she was diagnosed with Epilepsy at a very young age in her primary school days. With no history of such a condition in her family, it got everybody thinking what could have gone wrong with their lovely daughter. After days of trying to figure out, the family had to adapt to reality of their daughter living with Epilepsy. She was lucky to have very supportive parents ready to see her through the long journey of treating the condition. The motivation and support from her loved ones to access medication improved her status by far as she continued to adhere to the prescribed treatment. Unfortunately, the support didn’t last long and the burden of continuing with treatment squarely relied on her. This adversely contributed to the beginning of non-adherence to medication for lack of funds to buy drugs. Not only were finances a challenge but also finding a good hospital to comply was a problem.

Muthoni had to live with the sad reality of pain every time she experienced a seizure. Pain which she clearly knew with access to medication the situation could by far be controlled. At the very worse of her situation she found help. Cheshire Disability Services Kenya (CDSK) a Non-Governmental Organization in Kenya whose objective is to empower an inclusive society of persons with disability and develop their full potential to lead a quality life, in partnership with Kenya Association of People with Epilepsy (KAWE) came for Muthonis’ rescue.

Under CDSK’s program to help Epilepsy patients’ access medication and ensure compliance, Muthoni benefited and today she leads a life full of potential and energy as she explores her skills as a beauty and hair stylist.

As we celebrate International Epilepsy Day on Feb 12th 2018, themed on “Life is beautiful”, Muthoni’s story is a highlight of what beauty is all about. Hers’ is just but one of the many inspiring stories to celebrate during this season of Epilepsy Awareness.

Managing Adherence

Adherence to medication regardless of medical condition remains an important problem in treatment. Factors that have been discussed here – side-effects, drug regime, family support, impact on everyday life, relationship with the clinician – are unlikely to be the only predictors of adherence. While adherence to treatment within the context of epilepsy has been the focus of this review, these factors can equally be applied to various chronic conditions.

Assessment of adherence should be a routine part of management of epilepsy. Further recognition and support should be given to patients who have poor seizure control since they are more likely to be more anxious and have unhelpful illness and treatment beliefs.

Finally, patients may be fully aware of the importance of taking AED medication and the benefits gained by altering their lifestyle choices in order to prevent seizures, but will make a decision about the degree to which they follow advice. Patients only have a small amount of time in contact with the clinician in their “patient role”, after which they return to the practicalities of their everyday routine where their adherence fluctuates based on how they feel their medication affects their quality of life.

Strategies to manage adherence originate from different perspectives. While the medical model may advocate less complex drug regimes, the use of measured pill containers, and minimization of side-effects, the psychosocial model analyzes non-adherence in terms of patient attitudes to medication, stigma, family and peer influences, and ability to manage self care. Neither model can adequately improve adherence independently. Perhaps the best approach is to offer a “menu” of adherence-enhancing strategies. However, what is increasingly clear from both models is that total adherence is an unrealistic goal. The emphasis has shifted away from total adherence towards a compromise with both patient and clinician involved in a joint process of treatment negotiation and decision-making in order to achieve the best outcome for the individual.

 

via Medication Adherence Key to Epilepsy Treatment : Evewoman – The Standard

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